Ultimate Decision Maker Research Articles

Becoming the CEO: Identity Construction Process in CEO Transition (WITHDRAWN)

This article makes three contributions to the literature on CEO transition. First, it uncovers that new CEOs undergo a distinctive identity construction process in the beginning of their tenure that is influenced by three unique characteristics of the position: the lack of specificity of the CEO role, the challenges associated with being the ultimate decision maker and the perception of the CEO as embodiment of the organization. Second, it shows that these characteristics produce identity demands that dispose new CEOs towards expressing their individuality. Third, it indicates that new CEOs experience a reverse process of socialization wherein, as newcomers, they impart new values, attitudes and behaviors in the organization. This reverse process of socialization might explain how CEOs may shape the firm to reflect aspects of their identity. Implications of these findings for theory as well as for the ability of new CEOs to remain in post are discussed.

Promotion by Pharmaceutical Industry and Patients’ Perspective in Pakistan

The economy of Pakistan is significantly contributed by the pharmaceutical industry which is growing at a rapid rate. For pharmaceutical industry doctor is one of the most important stakeholders because he is the ultimate decision maker rather than the direct user. Pharmaceutical industry focuses on doctors rather than the direct users; BTL i.e. below the line marketing strategy is the basis of marketing in pharmaceutical industry, the importance of sales promotion officers as a marketing technique in pharmaceutical industry cannot be denied and ignored. In order to reach the doctors i.e. the prescribers, pharmaceutical industry takes the help of sales promotion officers that constitutes a major place in pharmaceutical marketing strategies. The connection of pharmaceutical industry with physicians is controversial due to the involvement of personal benefits and clash between money and ethics. Trust is one of the fundamental factors of patient-physician relationships, despite of its recognized significance and efforts to measure patient trust have been quite insufficient. This study investigates the patients’ perspective regarding the sales promotion by pharmaceutical industry, it highlights the viewpoint of one of the most important stakeholders of health care industry i.e. the patients regarding the matter. Questionnaire was used as the research tool to collect the primary data from patients, 100 questionnaires were filled up from a hospital of Karachi.

Do you really know your reporters? Evaluation methods of editors-in-chief

This article explores how leading Israeli news organizations evaluate the performance of their reporters in an era when evaluations are becoming more intensive and challenging, addressing new measures, pressures, and narrower margins of error concerning editorial employment. Data are based on in-depth interviews with 13 current and former editors-in-chief – the ultimate decision-makers on these matters. Findings indicate that evaluation is mostly impressionistic, informal, and aversive toward the uses of quantitative indicators. These tendencies are anchored in a deep belief that evaluating reporters is an ‘art’ more than a ‘science’. Editors’ evaluations are prone to huge blind spots, ignoring most reporters, who neither excel nor fail on a daily basis, overlooking audiences’ input, and reveal lack of awareness of the need to use evaluations as a public signaling system of quality in journalism.

Trust in the executive

Why is it so hard to get opposing elites to work together rather than to seek partisan gains and/or political survival? While the credible commitment problem is widely known, there are a number of lesser known obstacles to building trust and trustworthiness between opposing elites. This article presents an account of how some of those obstacles interact through time. Common institutional types, particularly winner-takes-all and power-sharing institutions, force trade-offs between agile responses in the short term and medium-term trust between elites, on the one hand, and between trust among elites in the medium term and the adaptability of agreements in the long term, on the other. We call this the ‘time horizon trilemma’. As an alternative approach, we consider a variant on the two-person consulate used by the Roman Republic for more than 400 years as Rome rose to prominence. In our variant, a ‘turn-taking institution’, opposing executives take short alternating turns as the ultimate decisionmaker within one term. We conduct behavioral games in the experimental lab to provide an initial estimate of the impact of these institutional types – winner-takes-all, requiring consensus only, requiring turn-taking only, or requiring both – on overcoming obstacles to agile responses in the short term, trust among elites in the medium term, and adaptability of agreements in the long term. We find that turn-taking is a promising alternative to solving the time horizon trilemma.

Should income be taken for granted as a sole driver of welfare? Bayesian insight on the relevance of non-income drivers of welfare

Abstract Abstract: The paper consists of a discussion on the relevance of non-income drivers of welfare. This discussion is based on a subjective Bayesian reasoning, where welfare perceptions are subjectively rational decisions of individuals, who are, as author suggests, the ultimate decision-makers in respect of what welfare actually means for them. The objective of the paper is to investigate if income should be taken for granted as a sole driver of welfare. The conclusion is drawn from a methodological investigation of this question in a Bayesian concept of probability with a consideration for correlations among income and non-income drivers of welfare. It suggests that income should not be taken for granted as a sole driver of welfare since the non-income factors, which are not correlated with income, appear to be relevantly affecting individuals’ perceptions of welfare with Bayesian probability of almost 65%. Thereby, the paper is a reaffirmation of a need for further research in the area of welfare measures that might constitute an alternative to income-dominated indicators. Its value emanates from unambiguous answer in favour of the relevance of non-income drivers across welfare perceptions, which, without Bayesian reasoning, could remain unsolved at the point of 50% odds for relevance (irrelevance).

Study Key Factors in Selecting Proper Location for Insurance Branches

Choosing the proper location is one of the most important implementation activities in industrial engineering for large-scale projects. So far, most researches has been done in this field. Location studies location is such important that today, it is used for places on the agenda, but these proceedings must be based on scientific approaches. Appropriate studies for location, in addition to the economic impact, has an influence on the performance of industrial units, social, environmental, cultural and economic affects in the constructed area. In this article we have tried to identify key factors to select proper place for insurance branches to be totally scientific, so that the ultimate decision maker ensures that the process of site selection be precise and comprehensive and make sure that it is not based on personal judgment. In this process it is important to consider all factors in location optimal insurance branches as well as the views of different interest groups in the deployment location.

Acceptability of microneedle-patch vaccines: A qualitative analysis of the opinions of parents.

Vaccines incorporated into microneedle-based patch platforms offer advantages over conventional hypodermic injections. However, the success and clinical utility of these platforms will depend on its acceptance among stakeholders. Minimal focus has been placed on determining parents' acceptability of microneedle-patch vaccines intended for paediatric use. This qualitative study probes the perceived acceptability of microneedle technology for paediatric vaccination in a parent population. Focus groups (n=6) were convened through purposive sampling of Cork city primary schools. Discussions were audio-recorded, transcribed verbatim, anonymised, independently verified and analysed by thematic analysis, with constant comparison method applied throughout. The opinions of 32 parents were included. All participants declared that their children were fully vaccinated. Five core themes were identified and defined as: (i) concern, (ii) suitability for paediatric use, (iii) potential for parental administration, (iv) the role of the healthcare professional and (v) special populations. Drivers for acceptance include; concerns with current vaccines and vaccination programmes; attributes of microneedle-patch (reduced pain, bleeding, fear and increased convenience) and endorsement by a healthcare professional. Barriers to acceptance include; lack of familiarity, concerns regarding feasibility and suitability in paediatrics, allergic potential, inability to confirm delivery and potential reduction in vaccine coverage. This is the first study to explore parental acceptance of microneedle-patch vaccines. Capturing the opinions of parents, the ultimate decision makers in paediatric vaccination, is crucial in the understanding of the eventual uptake of microneedle technology and therefore adds to literature currently available. This study has revealed that even "vaccine-acceptors"; parents who agree with, or do not question vaccination, will question the safety and efficacy of this novel method. Participants in this study remained tentative. However, the study has also revealed that endorsement by healthcare professionals could reduce this tentativeness, thereby identifying the role of healthcare professionals in disseminating information and providing support to parents. An increased awareness of developments in microneedle technology is needed to permit informed decision-making by parents.

The application of defaults to optimize parents' health-based choices for children

Optimal defaults is a compelling model from behavioral economics and the psychology of human decision-making, designed to shape or “nudge” choices in a positive direction without fundamentally restricting options. The current study aimed to test the effectiveness of optimal (less obesogenic) defaults and parent empowerment priming on health-based decisions with parent-child (ages 3–8) dyads in a community-based setting. Two proof-of-concept experiments (one on breakfast food selections and one on activity choice) were conducted comparing the main and interactive effects of optimal versus suboptimal defaults, and parent empowerment priming versus neutral priming, on parents' health-related choices for their children. We hypothesized that in each experiment, making the default option more optimal will lead to more frequent health-oriented choices, and that priming parents to be the ultimate decision-makers on behalf of their child's health will potentiate this effect. Results show that in both studies, default condition, but not priming condition or the interaction between default and priming, significantly predicted choice (healthier vs. less healthy option). There was also a significant main effect for default condition (and no effect for priming condition or the interaction term) on the quantity of healthier food children consumed in the breakfast experiment. These pilot studies demonstrate that optimal defaults can be practicably implemented to improve parents' food and activity choices for young children. Results can inform policies and practices pertaining to obesogenic environmental factors in school, restaurant, and home environments.

The appropriateness of today’s airport security measures in safeguarding airline passengers

The aim of this study is to find out whether the user anxiety created by today’s airport security measures changes depending on some individual user characteristics. To this end, 904 passengers were surveyed in the sterile area of Istanbul Ataturk Airport International Terminal, one of the crossway airports of the world. The data obtained were analyzed correlationally. It has been determined that, regarding airport security measures, anxiety levels of Muslim and African passengers are higher than those European passengers. Other independent variables that were thought to be relevant such as, age, status and education, have been found not to effect anxiety level. In the light of these findings, it is suggested that security measure procedures, especially biometrics, be supported by technology in order to lower passenger anxiety levels, considering their characteristics. Furthermore, ethically fostering the cognitive development of the security staff, who are the operators and ultimate decision makers of these measures, is considered to be an effective way to alleviate passenger anxiety.

Context-Dependent Score Based Bayesian Information Criteria

In a number of applications, we argue that standard Bayes factor model comparison and selection may be inappropriate for decision making under specific, utility-based, criteria. It has been suggested that the use of scoring rules in this context allows greater exibility: scores can be customised to a client's utility and model selection can proceed on the basis of the highest scoring model. We argue here that the approach of comparing the cumulative scores of competing models is not ideal because it tends to ignore a model's ability to 'catch up' through parameter learning. An alternative approach of selecting a model on its maximum posterior score based on a plug in or posterior expected value is problematic in that it uses the data twice in estimation and evaluation. We therefore introduce a new Bayesian posterior score information criterion (BPSIC), which is a generalisation of the Bayesian predictive information criterion proposed by Ando (2007). This allows the analyst both to tailor an appropriate scoring function to the needs of the ultimate decision maker and to correct appropriately for bias in using the data on a posterior basis to revise parameter estimates. We show that this criterion can provide a convenient method of initial model comparison when the number of models under consideration is large or when computational burdens are high. We illustrate the new methods with simulated examples and real data from the UK electricity imbalance market.

Independent Directors: One Head, Two Hats - A Mismatch between Delaware Corporate Law and Federal Securities Law

Although both federal securities law and Delaware corporate law have increasingly relied on independent directors in improving corporate governance, there is a fundamental mismatch between these two regimes. Federal securities law relies on independent directors to monitor the management of the corporation, while Delaware corporate law posits the independent directors as the ultimate decision-makers of the corporation, particularly in transactions in which insiders’ interests or incentives are in question. This mismatch emerged in the 1970s, when proponents of the “monitoring board” successfully campaigned for a board structure consisting of a majority of independent directors, in an attempt to transform corporate boards from ceremonial “advisory boards” to active monitors of management performance. While the SEC followed the monitoring board model, several key decisions of the Delaware courts beginning in the 1980s emphasized the decision-making function of the board, and in particular, the role of independent directors in fundamental transactions. This mismatch became salient after the Enron scandal and the 2008 financial crisis, as the SEC gained the authority to promulgate more stringent rules enhancing the independence of the board under Sarbanes-Oxley and Dodd-Frank. The mismatch may be explained either as a philosophical difference between securities regulators and Delaware judges or as an institutional difference between federal legislative bodies and common law courts. One consequence of the mismatch is that, because of the inherent tension between the monitoring and decision-making functions, independent directors are destined to under-perform both functions. I propose several solutions to reconcile the dueling functions of the board.

Attitudes towards human papillomavirus vaccination among African parents in a city in the north of England: a qualitative study.

BackgroundHuman papillomavirus (HPV) is sexually transmitted and has been conclusively linked to cervical cancer and genital warts. Cervical cancer is attributed to approximately 1100 deaths annually in UK, and is the second most common female cancer globally. It has been suggested that black African women are more predisposed to HPV infection and cervical cancer. A vaccine has been developed to reduce HPV infection, and in the UK, has been offered to 12–13 year old adolescent girls through schools as part of their childhood immunization programme since 2008. Upon programme initiation, it was noted that vaccine uptake was lower in schools where girls from ethnic minority groups were proportionately higher.The study’s objectives were to explore factors influencing UK based African parents’ acceptance or decline of the HPV vaccine, whether fathers and mothers share similar views pertaining to vaccination and any interfamily tensions resulting from differing views.MethodsA qualitative study was conducted with five African couples residing in north England. Face to face semi-structured interviews were carried out. Participants were parents to at least one daughter aged between 8 and 14 years. Recruitment was done through purposive sampling using snowballing.ResultsHPV and cervical cancer awareness was generally low, with awareness lower in fathers. HPV vaccination was generally unacceptable among the participants, with fear of promiscuity, infertility and concerns that it’s still a new vaccine with yet unknown side effects cited as reasons for vaccine decline. There was HPV risk denial as religion and good cultural upbringing seemed to result in low risk perceptions, with HPV and cervical cancer generally perceived as a white person’s disease. Religious values and cultural norms influenced vaccine decision-making, with fathers acting as the ultimate decision makers. Current information about why the vaccine is necessary was generally misunderstood.ConclusionTailored information addressing religious and cultural concerns may improve vaccine acceptability in African parents.

Sanctions and the Iranian Nuclear Deal: Silver Bullet or Blunt Object?

Sanctions and the Iranian Nuclear Deal: Silver Bullet or Blunt Object? Suzanne Maloney (bio) since the seizure of the american embassy in tehran more than 36 years ago, economic sanctions have been at the heart of Washington’s strategy for dealing with Iran. For most of that period, sanctions carried more symbolic than strategic value. That changed dramatically over the course of the past decade as Washington erected a far-reaching set of restrictions on Tehran’s access to the international financial system and persuaded the world to abide by the measures and to curb investments and trade with Tehran. This pressure had a devastating impact on Iran’s oil exports and revenues, the value of its currency, and the stability of its economy as well as the confidence of its citizens. In June 2013, Hassan Rouhani was elected to the Iranian presidency on a platform of ending Tehran’s debilitating impasse with the world over its nuclear program. Over the course of the subsequent months, the long-stalemated negotiating process assumed a new urgency and the two sides moved fitfully toward a final agreement, signed in July 2015. In the wake of Rouhani’s election and the intensification of the nuclear talks, the issue of economic sanctions emerged as a crucial factor in the apparent shift in Iran’s approach to the nuclear standoff and to the success of the negotiations themselves. And after decades of skepticism about their utility, sanctions were widely credited with turning Tehran toward a more moderate leadership and facilitating the diplomatic breakthrough. [End Page 887] That assessment was substantially correct: the fierce multilateral sanctions regime erected between 2007 and 2013 played a pivotal role in persuading Iran to abandon its recalcitrance toward the nuclear negotiations with six world powers, including the United States. Even Ayatollah Ali Khamenei, who serves as Iran’s supreme leader and its ultimate decisionmaker, has acknowledged that the primary purpose of Iran’s diplomatic engagement with the nuclear issues was to release the external economic pressure on his country. “We negotiated so that the sanctions framework will be eliminated and that sanctions in general will be lifted,” Khamenei said in September 2015. “We could have continued our research in the same way and at the same rate and we could have done other things. The reason why we entered into negotiations and made some concessions was to lift sanctions” (Khamenei.ir 2015). The supreme leader also reinforced the causal relationship between the sanctions and the decision to press for a resolution of the nuclear issue in his October 2015 letter to Rouhani that endorsed the deal. Impact is not efficacy, however. While sanctions played a role in shaping Iranian decisionmaking on whether and how to negotiate, it is less obvious that they contributed to generating the most optimal outcome. Ultimately, the text of the final deal concluded in July 2015 by Tehran, the United States, and five other world powers (Russia, China, Britain, France, and Germany) suggests a more ambivalent bottom line for the utility of sanctions in achieving specific foreign policy goals. The disparity between the agreement’s sweeping sanctions relief and the more parsimonious scope of its constraints on Tehran’s nuclear activities underscores the limitations to the use of sanctions as leverage in the negotiations themselves. A review of the factors contributing to the impact of the Iran sanctions as well as the limitations on their utility offers a useful corrective to the recent infatuation with sanctions and the corresponding tendency to overestimate their efficacy in solving international problems without the use of military force. Sanctions may have been the silver bullet that brought Iran back to the negotiating table, but [End Page 888] they proved too blunt an instrument to advance the most advantageous terms of a deal. The Efficacy of Iran Sanctions: What Worked The first United States sanctions levied against Tehran went into effect in response to the November 1979 seizure of the US embassy in Tehran. Although those measures were lifted in early 1981 as part of the agreement that freed the US personnel held hostage by the Iranian government, Washington applied some level of economic restriction against Tehran for the better part...

Gender Participation on Rice Post-harvest Activities in Bangladesh

The study was undertaken to examine the extent of women along with men participated in post-harvest activities; to identify the problems and constraints faced by them and find suitable solution from their perception. The post-harvest activities were estimated at farm level in Aman rice at Rangpur, Nilphamari, Khulna, Satkhira and Jessore district of Bangladesh by using survey data collected randomly from 270 rice growing households for the year 2012-13. It employed participatory approaches to investigate farmers’ perceptions on post-harvest management. The analyses shows women spends more time (591 hours ha-1) on PH activities than men (581 hours ha-1) but the ultimate decision maker of those activities are male indicating that women are very seldom given the opportunities to implement their ideas for execution although they are now gaining the right to give their opinion because of social awareness.J. Environ. Sci. & Natural Resources, 8(1): 45-50 2015

Boards of Directors in Tourism Organizations: Roles and Innovative Climates

As the ultimate decision makers in organizations, boards of directors have a strong influence on organizational success. This study contributes to better understanding of the mechanisms of boards within the tourism sector, more precisely, destination-based tourism organizations wherein several stakeholders collaborate. First, we examine how tourism directors perceive their roles including strategic, control and service roles. Second, as tourism organizations are in a constant need for development and innovation, we study the role of innovative climates as part of the board dynamics. Third, we compare limited liability companies with other tourism organizations to explore the influence of legal structure on the perception of board roles and innovation. The directors perceived the control and strategic tasks as the most relevant for the boards of tourism organizations. Furthermore, they reported generally high scores on climate for innovation with somewhat stronger emphasis on the performance-related climate factors “objectives – mutual and achievable goals” and “task orientation – focus on excellence” than the factors more closely related to social relationships (“support” and “participative safety”). Limited liability companies scored significantly higher on the control and strategic roles as well as the combined climate for innovation variable indicating a stronger investment in the organizations due to the legal responsibility linked to the role of director in such organizations.

Roles and responsibilities in newborn care in four African sites.

ObjectivesTo explore roles and responsibilities in newborn care in the intra‐ and postpartum period in Nigeria, Tanzania and Ethiopia.MethodsQualitative data were collected using in‐depth interviews with mothers, grandmothers, fathers, health workers and birth attendants and were analysed through content and framework analyses.ResultsWe found that birth attendants were the main decision‐makers and care takers in the intrapartum period. Birth attendants varied across sites and included female relatives (Ethiopia and Nigeria), traditional birth attendants (Tanzania and Nigeria), spiritual birth attendants (Nigeria) and health workers (Tanzania and Nigeria). In the early newborn period, when the mother is deemed to be resting, female family members assumed this role. The mothers themselves only took full responsibility for newborn care after a few days or weeks. The early newborn period was protracted for first‐time mothers, who were perceived as needing training on caring for the baby. Clear gender roles were described, with newborn care being considered a woman's domain. Fathers had little physical contact with the newborn, but played an important role in financing newborn care, and were considered the ultimate decision‐maker in the family.ConclusionInterventions should move beyond a focus on the mother–child dyad, to include other carers who perform and decide on newborn care practices. Given this power dynamic, interventions that involve men have the potential to result in behaviour change.

Publication and dissemination of Annual Reports to shareholders in Nigeria and the United Kingdom: The Economics of Social Media and Electronic Communication

While the cost of printing and sending out annual reports to shareholders by companies keep increasing and arguments have been made for cheaper and cost-effective ways of carrying out financial disclosure obligations by companies including electronic method, Companies’ Acts maintain that shareholders remain the ultimate decision-maker in the question whether electronic means of publishing annual reports is to be adopted as the primary means of publishing and disseminating annual reports among shareholders. This line of reasoning by legislation is given impetus by the staple assumption that shareholders take the form of owners of the companies of which they are members and the question of what mode of publication and dissemination of annual reports, whether electronic or hard copy remains their exclusive preserve. However, a case is made for a more cost-effective means of carrying out companies’ disclosure obligation through the vehicle of social media and electronic means.

Impacts of Urban Logistics Measures on Multiple Actors and Decision Layers

An approach for a multiagent model on urban commodity transport is presented. Special attention is paid to the relationship between shippers and carriers. Shippers choose lot sizes, and they commission one or several carriers. Carriers consolidate shipments in hub-and-spoke-transport networks or in en route pickup and delivery tours. Shippers and carriers interact in a transport market where carriers submit offers to the shippers. The effects of urban transport policy measures are transmitted to the ultimate decision makers in transport—the shippers—via prices. Transport tariffs are calculated on the basis of full cost using an activity-based costing schema. The model assesses the effects of a cordon toll in the Tokyo metropolitan area to shippers and carriers. In particular, it analyzes the impacts on market shares and the spatiotemporal structure of truck flows.

The complexity of clinical alarm systems.

Healthcare technology management (HTM) is ideally suited to take a leadership role within healthcare organizations on the subject of clinical alarm systems, because technology issues are a major part of the overall alarm picture. In order to do so, they need to be an excellent knowledge source on the subject. If an HTM department is currently only marginally involved in clinical alarm systems, I strongly encourage it to use the information gained from this article to become part of the core team. Because the clinicians need to live with consequences of clinical alarms decisions on a daily basis, they should be the ultimate decision makers. There has been a lot of attention given to the subject of clinical alarm systems since the 2011 Clinical Alarm Summit was convened by AAMI, the U.S. Food & Drug Administration (FDA), The Joint Commission (TJC), the American College of Clinical Engineering (ACCE) and ECRI Institute. The AAMI Foundation’s Healthcare Technology Safety Institute (HTSI) has spearheaded follow-up work on the issues raised by the summit, and has set up an online resource page at www.aami.org/htsi/ alarms that is definitely the best and most complete collection of resources on the subject. If you are not familiar with this website, you need to be. If you haven’t visited the site recently, you need to—additional resources and webinars are being added continually. Healthcare leadership’s interest in alarm systems increased when TJC published a National Patient Safety Goal paper on the subject. The purpose of this article is not to try and summarize all of the great work being disseminated on clinical alarms. Instead, the purpose is to sift through the blizzard of information on the topic and highlight those parts of the overall picture that others may have missed as they address clinical alarm systems. Hopefully, the selections will help clarify issues and/or stimulate important discussion, rather than simply adding to the blizzard.

Determinants of institutional childbirth service utilisation among women of childbearing age in urban and rural areas of Tsegedie district, Ethiopia

Backgrounddespite receiving greater attention, optimal maternal health remains a challenge in developing countries such as Ethiopia. Evidence from various studies shows that skilled attendance during childbirth is among the key strategies to reduce maternal mortality. However, in Ethiopia, the use of institutional childbirth services is very low. In Ethiopia, studies dealing with factors affecting women׳s use of institutional childbirth services are scarce and generally focus on urban settings. As such, this study aimed to explore the determinants of institutional childbirth service utilisation among urban and rural women who gave birth in the previous two years in Tsegedie district, Ethiopia. Methodsa community-based cross-sectional study was performed from 20 November 2012 to 30 June 2013 on 485 mothers. The participants were selected systematically using a multistage sampling technique. A pre-tested structured questionnaire, administered by an interviewer, was used to collect quantitative data. Focus group discussions and in-depth interviews were used to triangulate the evidence from the quantitative study. Bivariate and multivariate data analysis was performed using Statistical Package for the Social Sciences Version 17.0. Findingthis study found that 31.5% of the respondents used institutional childbirth services. The main reason for home birth was close attention from family (47%). Women׳s educational status [adjusted odds ratio (AOR) 5.3, 95% confidence interval (CI) 1.59–17.87], time taken to reach the nearest health facility (AOR 3.3, 95% CI 1.15–9.52), ultimate decision maker regarding the place of childbirth (AOR 3.7, 95% CI 1.08–12.63) and receipt of maternal and child health care information (AOR 9.4, 95% CI 2.4–36.38) were significantly associated with the use of institutional childbirth services. Conclusionthe proportion of births attended in health facilities was low in the study district. Women׳s educational status, distance to the nearest health facility, women׳s decision-making power and receipt of maternal and child health care information were important predictors of institutional childbirth service utilisation. This implies that women still lack physical and effective access to maternal health care services. Thus, improving community awareness about skilled providers and institutional childbirth, targeting women who prefer to give birth at home, is encouraged. Safe motherhood education using communication networks in rural and urban communities is crucial. Furthermore, it is recommended that essential obstetric care facilities (health centres) should be established within a reasonable distance of homes, women should be empowered and community midwives should be deployed.