Institutional Delivery Service Utilization Research Articles

Evaluation of a community-based intervention package to improve knowledge of obstetric danger signs, birth preparedness, and institutional delivery care utilization in Arba Minch Zuria District, Ethiopia: a cluster-randomized trial

IntroductionMaternal healthcare utilization, particularly the institutional delivery, is disproportionately low in rural Ethiopia. This study aimed to evaluate the effectiveness of an integrated package of community-based interventions on the improved knowledge of obstetric danger signs, birth preparedness, and institutional delivery services utilization in rural areas of Gamo zone, southern Ethiopia.MethodsWe conducted cluster-randomized controlled trial (NCT05385380) from 2019 to 2021 at the Arba Minch Health and Demographic Surveillance System site. We randomly assigned the 10 kebele clusters to intervention and control arm. We used a package of interventions, which included providing information on safe motherhood via video and/or audio with a birth preparedness card for pregnant women, training for community volunteers and health extension workers, and improving maternity waiting home services. Women in the control arm received routine services only. We used generalized mixed-effects logistic regression models to evaluate the effectiveness of the intervention on the outcome variables.ResultsThe study enrolled 727 pregnant women across the 10 clusters, with a 617 (84.9%) successful follow-up rate. The proportion of institutional delivery in the intervention arm was increased by 16.1% from 36.4% (174/478) at the baseline to 52.5% (224/427) at the endline (Adjusted odds ratio [AOR] for McNemar’s Test = 1.5; 95% confidence interval [CI]: 1.1 to 2; p < 0.001). In the control arm, however, there was a 10.3% fall in the proportion of institutional delivery (from 164/249 to 105/190). Pregnant women who received the intervention were significantly more likely to give birth in a health institution than those who did not (AOR 2.8; 95% CI: 1.2, 6.4).ConclusionThe study demonstrates that an integrated community-based intervention package that included video-based storytelling and upgrading maternity waiting homes increased institutional delivery care utilization among rural women. We recommend that audio-visual storytelling, starting during pregnancy and continuing postpartum, be incorporated into routine maternal healthcare services to address access to care inequalities in rural settings.Trial registration: The study protocol was registered in the clinicaltrials.gov with registry number NCT05385380.

Institutional delivery utilization and associated factors among delivered women in Dawuro Zone, Southern Nation Nationalities Peoples Region.

Globally, around 13.6 million maternal deaths occurred in the last 25 years. Ethiopia accounts one of the highest global maternal deaths, with more than 50% of births taking place at home. Hence, the aim of this study was to determine institutional delivery utilization in Waka town. Community based cross sectional study is the study design chosen. The study was conducted, on mothers having a history of at least 1 birth within the last 2 years, who were selected by a systemic random sampling (K=2), from both kebeles, which is selected by a simple random sampling from the 2 kebeles in the study area. For data collection, an interview with questionnaire containing both closed and open-ended questions, along with non-participant observation method was employed. For analysis, descriptive statistics, along with bivariate and multivariate analytical method was computed. Statistical significance was considered at p < 0.05, and the strength of statistical association was assessed by odds ratio (OR) with 95% confidence interval. The prevalence of institutional delivery service utilization in Waka town was found to be 89.4%. Educational status, marital status, intention of the pregnancy, ANC follows up, and Knowledge of birth complications have shown significant association.

Determinants of institutional delivery service utilization in Nepal.

Maternal mortality continues to be a pressing concern in global health, presenting an enduring and unmet challenge for healthcare systems worldwide. Utilization of institutional delivery services has been established as a proven intervention to mitigate life-threatening risks for both mothers and newborns. Exploring the determinants of institutional delivery is crucial to improve and enhance maternal and newborn safety. This study aimed to assess the contextual and individual factors associated with institutional delivery in Nepal. This study utilized that data form Nepal Multiple Indicator Survey 2019, which included a sample of 1,932 women who had given birth within the two years prior to the survey. A multilevel logistic regression analysis was performed to determine the significant external environment, contextual and individual predictors of institutional delivery. The women from Madhesh province [Adjusted Odds Ratio (aOR): 0.32, 95% Confidence Interval (CI): 0.17-0.61], as compared to Bagmati province, women from rural areas (aOR: 0.55, 95% CI: 0.39-0.78) as compared to urban areas, and women from a relatively less-advantaged ethnic groups (aOR: 0.52, 95% CI: 0.35-0.76) as compared to the relatively advantaged ethnic groups were less likely to deliver in health institutions. Similarly, women from the poorest (aOR: 0.09, 95% CI: 0.04-0.22) and second wealth groups (aOR: 0.29, 95% CI: 0.13-0.64) were less likely to attend institute for delivery compared to women from the richest household. Women with formal education (aOR: 1.65, 95% CI: 1.16-2.35) were more likely to deliver in an institution over uneducated women. Moreover, the uptake of institutional delivery increased by 59% (aOR: 1.59, 95% CI: 1.43-1.75) for each additional ANC visit. The findings highlight the importance of stepping up efforts to achieve universal health care from the standpoint of long-term government investment, focusing particularly on illiterate women in rural areas, poorer households, and socially disadvantaged groups. Expanding the benefits of maternal benefit schemes targeting the women from the poorest households in the communities is recommended.

Factors influencing the utilization of institutional delivery services by Chepang women in Chitwan district of Nepal

Factors influencing the utilization of instituional delivery services by Chepang women in Chitwan district of Nepal Background To reduce the maternal death rates, a safe motherhood program has been implemented across Nepal to provide pregnant women with free delivery care in a healthcare facility, as well as transportation incentives promoting institutional delivery. Being a marginalized group of people residing in hilly slope areas, the Chepang population lacks significant usage of healthcare services. Objective This study aimed to assess the incidence of delivery complications, and to investigate the factors associated with the utilization of institutional delivery of the Chepang women in the Chitwan district. Methods A cross-sectional study was conducted with a proportional random sample of 557 mothers. A face-to-face interview was performed to collect the data. Using stepwise logistic regression analysis, the data were analyzed. Results The results showed low incidence of delivery complications among those who utilized an institutional delivery. The literate parents were strongly associated with the increased usage of an institutional delivery (OR=12.08, 95%CI=6.32-23.06, and OR=5.45, 95%CI=2.82-10.51 for literate mothers and literate spouses, respectively). Other significant factors were older ages at delivery of mothers as compared to younger ages mothers (OR= 3.28, 95%CI=1.83-5.90 for ages 20-29 yr.; OR=3.75, 95%CI=1.80-7.83) for ages ≥30 yr.), and engagement in business and services occupation of mothers (OR=2.01, 95%CI=1.01-4.01). The associations were observed for vehicle transportation to the delivery facility (OR =1.99, 95% CI =1.28-3.11) and travel time ≤30 minutes to the delivery facility (OR=2.80, 95%CI=1.58-4.96). Conclusions The results revealed a lower incidence of delivery complications among those who utilized the institutional delivery. The analysis also demonstrated that age, education, income, and convenient access to an institutional delivery facility were associated with the utilization of institutional delivery. Keywords: Institutional delivery, Multilevel analysis, Chepang Women, Chitwan District, Nepal

Delay in receiving emergency obstetric care and associated factors among mothers who gave birth in public hospitals of Bale and East Bale zones, Oromia region, South East Ethiopia: Facility based cross-sectional study

IntroductionDelays in timely seeking care, failure to reach health institutions and receiving ineffective health care cause maternal mortality in developing countries. The three maternal delay was used to identify contributing factors to maternal death. There was limited data on the maternal delay in receiving emergency obstetric care services in the study area. Therefore, the aim of this study was to assess the magnitude of delay in receiving emergency obstetric care and associated factors among postnatal mothers in the Bale and east Bale zones. MethodsA facility-based cross-sectional study was conducted among 407 postnatal women from April 6 to May 6, 2022. A systematic random sampling technique was used to select study participants. The data were collected electronically using an Open Data Kit and exported to SPSS window version 25 for cleaning and analysis. Both bivariate and multivariable analyses were done by using a binary logistic regression model to identify factors associated with delay in receiving emergency obstetric care services. Statistical significance was declared at P-value < 0.05. ResultsIn this study, the magnitude of delay in receiving institutional delivery service utilization was 34.6% with [95% CI (30.0_39.5)]. Delay one was found to be statistically associated with maternal delay in receiving institutional delivery services (AOR = 2.07; 95% CI: 1.21, 3.53). Mothers with low monthly income had shown higher odds of delay (AOR = 1.79; 95% CI: 1.03, 3.10). Moreover, the delay in receiving emergency obstetric care was 89% less likely among mothers who had not been referred multiple times than among those who had been referred many times (AOR = 0.10; 95% CI: 0.06, 0.18). ConclusionThis study showed that the magnitude of the delay in receiving the utilization of emergency obstetric care services in the study area was high. Factors such as delay one, average monthly income and multiple referrals of mothers were found significant factors for delay in receiving care. Therefore, it is important to reduce delay in receiving institutional delivery by working on promoting road accessibility, transport mechanisms and building health education on key danger signs.

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

BackgroundConflict-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. MethodsA 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. ResultsOf 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). ConclusionInstitutional 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.

Factors Influencing the Utilization of Antenatal Care, Institutional Delivery, and Postnatal Care Services Among Women in Bangladesh

Background: In Bangladesh, the utilization of maternal health services is low, which triggers pregnancy-related complications and maternal deaths. The current community-based cross-sectional study aims to evaluate the factors associated with antenatal care (ANC), institutional delivery, and postnatal care (PNC) service utilization among women in selected areas of Southwest Dhaka, Bangladesh.

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

BackgroundEthiopia 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.MethodsA 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.ResultsInstitutional 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.ConclusionThe 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.

Determinants of default from full completion of vaccination among children between 12 and 23 months old in Yilmana Densa district, west Gojam zone, Ethiopia, 2019.

BackgroundVaccination is one of the best cost-effective public health interventions to safeguard children from vaccine-preventable diseases. In Ethiopia, the prevalence of default to the full completion of child immunization is high. However, the determinants of default to full completion have not been thoroughly investigated in this study area. Therefore, this study assessed the determinants of default to the full compilation of vaccination among children between 12 and 23 months old in Yilmana Densa District, west Gojam, northwest Ethiopia.MethodsA community-based unmatched case-control study design was employed in the Yilmana Densa district among 343 (111 cases and 232 controls) randomly selected 12–23 months old children. Face-to-face interviews were used to collect data using a multistage sampling method. For analysis, data were entered into epidata version 3.1 and exported to SPSS 23 software. Descriptive analysis followed by binary and multivariable logistic regression analysis was conducted. The statistical significance was declared at a p-value of 0.05.ResultThis study identified that mothers who had not attended ANC follow-up [AOR = 5.55, 95% CI: (1.789–17.217)], mothers who had not gotten information about vaccinations [AOR = 8.589, 95% CI: (4.414–16.714)], and mothers whose time taken to reach vaccination site is more than 39 min were at higher risk to default from completion of vaccination [AOR = 3.252, 95% CI: (1.952–5.417)]. Furthermore, maternal waiting time (>45 min) for child vaccination [AOR = 2.674, 95% CI: (1.517–4.714)] and home delivery [AOR 3.19, 95% CI: (1.751–5.814)] were risk factors to default child from full completion of vaccination.ConclusionMothers delivered at home, mothers not attending ANC follow-up, mothers who did not get health information about the vaccine, mothers taking longer time to reach the vaccination site, and staying longer time for child vaccination are causes of default. Motivated institutional delivery services utilization is recommended. The district office should consider the distribution of vaccination sites by the opening of new outreach site to reduce the waiting time of mothers.

Improving access to and use of maternal health services during COVID-19: Experience from a health system strengthening project in Guinea.

The purpose of this study was to document the experience of health providers' capacity strengthening during health crises and the contribution of such to the health system and the population resilience in the face of the COVID-19 pandemic in Guinea. We conducted a cross-sectional study using routine data collected from 41 health facilities in the project intervention areas, including associative health centers, community health centers, and district hospitals,. These data covered the period between 2019 and 2021. Results showed that all the community health centers (CMCs) had a clean internal and external environment, compared to health centers (95.2%) and district hospitals (33.3%). Hand washing was systematic among visitors attending CMCs and district hospitals (HPs). However, 28.6% of visitors attending associative health centers (AHCs) did not wash their hands. Temperature taking for visitors was not carried out in all CMCs and in 90.5% of the AHCs; unlike in the HC and HP where the temperature of each patient was taken before entering the consultation room. The obligation to wear masks was higher in the HP and in the HC, compared to the CMC and AHC where the order of non-compliance with the wearing of masks was, respectively 36.4 and 19%. Non-compliance with social distancing in the waiting rooms and between users was observed in all facilities. The project's interventions mainly contributed to improving the utilization of prenatal consultation and institutional delivery services; the beginning of the interventions was marked by an increase of an average of 17 ANC1 per month in CMCs and 116 ANC1 in health centers. Ongoing training on capacity strengthening for providers in infection prevention and control, followed by the offering of delivery kits and materials during epidemics, would contribute to the improvement and utilization of health facilities by the population.

Assessing essential new born care practice and associated factors in mothers who gave birth within the last 6 months in east badewacho woreda, hadiyya zone, Ethiopia

Background: Every year, more than 2.7 million new-borns die before reaching neonatal age in the world, with the majority of these deaths occurring at home. Surprisingly, half of these occur within the first 24 hours of delivery, and 75% occur in the early neonatal period. One low-cost approach to improving new-born baby health outcomes is to promote essential new-born care practices. Objective: Thus, the purpose of this study was to evaluate essential new-born care practices and associated factors among mothers who gave birth within the last 6 months in East Badewacho woreda, Hadiyya zone. Methods: From March 1 to April 30, 2018, a community-based cross-sectional study was designed. The sampled population consisted of 399 mothers who had live births within the previous six months, as determined by a multistage random sampling technique. The data was collected using a semi-structured questionnaire and entered into Epi-data version 3.1 before being exported to SPSS version 21 for analysis. A binary logistic regression analysis with a 95% confidence interval was performed. Results: Less than half of the mothers (34.1 %) practice essential new-born care. The husband's educational status [AOR=0.24, CI (0.089, 0.64)] and [AOR=0.314, CI (0.126, 0.78)], place of delivery [AOR=0.024, CI (0.009, 0.068)] and knowledge of essential new-born care [AOR=2.03, CI (1.223,3.371)] were significant predictors of essential new-born care practice. Conclusion: The study's findings revealed that essential new-born care was not widely practiced in East Badewacho Woreda. As a result, strengthen the link between health centers and health posts in order to increase ANC, institutional delivery, and PNC service utilization.

Delay in Reaching Institutional Delivery Service Utilization among Mothers Attending Jimma Medical Center, Ethiopia.

Maternal delay in the utilization of delivery services is one of the contributing factors for high maternal mortality in developing countries. However, it is preventable by timely arrival for obstetric care. The difference between life and death in obstetrics might be a matter of timely arrival and management. The objective of this study was to assess factors associated with maternal delay in reaching institutional delivery service utilization among mothers attending Jimma Medical Center. Facility-based cross-sectional study design was employed. The sample size was determined by a single population proportion formula and entered into epi data version 3.1, then exported to SPSS version 23. The data was presented using texts and tables. Binary and multivariable logistic regression analysis with 95% CI for odds ratio (OR) was used to assess the factors. The prevalence of maternal delay in reaching institutional delivery service utilization was 163(40.2%). Low husbands' educational levels were significantly associated with delay in reaching: illiterate (AOR=4.22, 95% CI: 1.10-16.19), primary (AOR=3.88, 95% CI: 1.24-12.1). Mothers who live in rural areas have been delayed 2 times more than mothers who live in urban areas (AOR=2.22, 95% CI: 1.044-4.73). Likewise, mothers who live a long distance from health facilities are 13 times more likely to delay than mothers who live ≤ 10 kilometers (AOR= 12.89,95%CI:6.66-24.94). Delay in reaching institutional delivery service was high. Factors such as husband's education, distance of health facility, and living area were significant factors with delay in reaching.

Factors Associated With Utilization of Institutional Delivery Service during Covid-19 Pandemic.

The utilization of institutional delivery services is pivotal to improve maternal health and reducing maternal mortality amid childbirth. But COVID-19 pandemic is posturing considerable challenges to maintain essential maternal and newborn health services. So study aims to assess the factors associated with the utilization of institutional delivery during the COVID -19 pandemic. Data was collected from the 116 mothers of Kalika Municipality, Chitwan. The total enumerative sampling technique was used to include mothers who delivered a baby during lockdown (March 21 to August 21, 2020). Collected data were analysed by using descriptive and inferential statistics like chi-square test, logistic regression analysis. Out of 116 mothers, 76.6% had their delivery in the health facilities. Logistic regression analysis showed several factors associated with utilization of institutional delivery such as ethnicity, respondents education status, distance to the nearest health facility, fear of traveling, fear to visit health facility (AOR= 4.923; 95% CI =1.475-16.432, p=0.001),perception on the risk of covid-19 to mother, and intrauterine transmission of COVID-19 (AOR= 19 5.472;95% CI 1.35-22.175;p= 0.017) was found to be statistically significant with the utilization of institutional delivery during COVID-19 pandemic. Several factors have been associated with the utilization of institutional delivery during pandemic. Women preferred not to seek healthcare due to the fear of being infected, lack of awareness, and misperception about COVID-19 and pregnancy. Therefore, the concerned authority should need to deliver a separate message to the pregnant women for a regular check-up and deliver a baby at a hospital.

Individual and Community-Level Determinants of Institutional Delivery Services among Women in Bangladesh: A Cross-Sectional Study.

Background Improving maternal mortality attracts considerable interest with the critical invention through institutional delivery services (IDS) in reducing maternal death during delivery and ensuring safe childbirth. The influence of both individual and community-level factors is essential to using IDS. Problem Statement. Maternal death may occur at any time, but delivery without designated healthcare is by far the most dangerous time for both woman and her baby. Therefore, to combat the global burden of maternal mortality, it is necessary to ensure IDS worldwide. Objectives This study explores the current knowledge of individual and community-level covariates and examines their extent of influence on the utilization of IDS in Bangladesh. Methods Utilizing Bangladesh Demographic and Health Survey (BDHS) data, this study has used two-level random intercept binary logistic regression, together with the average annual rate of increase (AARI) in the utilization of IDS and related variables. Results This study found appreciable changes in seeking IDS, increases from 3.4% in 2007 to 51.9% in 2017, and half of the total deliveries (51%) took place in healthcare. About 26% of the total variation in the utilization of IDS is owing to differences across communities. Further, covariates including communities with higher educated women, higher utilization of ANC and access to media and at individual level, religion, maternal and parental education, wealth index, and mother-level factors (i.e., age at birth, BMI, occupation, ANC visit, birth order, own health care decision, pregnancy intention, and exposure to media) showed significant association with the utilization of IDS. Conclusion This study observed the association between individual and community-level factors and IDS uptake. Thus, any future strategies must address individual level and community-level challenges and undertake a multisectoral approach to enhance the uptake of IDS.

Determinants of Utilization of Institutional Delivery Services in Zambia: An Analytical Cross-Sectional Study.

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.

Magnitude, Trends, and Determinants of Institutional Delivery Among Reproductive Age Women in Kersa Health and Demographic Surveillance System Site, Eastern Ethiopia: A Multilevel Analysis.

BackgroundInstitutional delivery service utilization is a critical and proven intervention for reducing maternal and neonatal mortality. Institutional delivery service utilization can improve maternal health and wellbeing by ensuring safe delivery and reducing problems occurring during childbirth. In Ethiopia, almost all previous researches were cross-sectional studies and most of them were based on small sample sizes and there are no sufficient reports for the trends. Therefore, this study aimed to assess the magnitude, trends, and determinants of institutional delivery using surveillance data from the Kersa Health and Demographic Surveillance System (HDSS), in Eastern Ethiopia from 2015 to 2020.MethodsThe study was conducted among reproductive-aged women selected from the Kersa HDSS site, Eastern Ethiopia for the duration of 2015 to 2020. Data were extracted from the Kersa HDSS database system. After coding and recoding, the data was exported to R software for further analysis. A chi-squared test was used for trends to examine the significance of the change. A multilevel logistic regression model was fitted to identify determinants of institutional delivery. An adjusted odds ratio with a 95% confidence interval (CI) was used to measure the strength of the associations. Statistical significance was declared at a p-value < 0.05.ResultsA total of 20,033 reproductive age women were employed for analysis. The overall magnitude of institutional delivery was 45.03% with 95% CI (44.33–45.72). The institutional delivery has shown a decreasing trend over the 6 years' and there is statistical significance for the declining. Semi-urban resident [AOR = 2.33, 95% CI: 1.37–4.48], urban resident [AOR = 7.18, 95% CI: 5.24, 8.71], read and write [AOR = 1.54, 95% CI: 1.18, 2.01], literate [AOR = 1.46, 95% CI: 1.34–1.59], and antenatal care [AOR = 1.73, 95% CI: 1.58–1.88] were significantly associated with institutional delivery.ConclusionThe magnitude of institutional delivery was relatively low and has shown a decreasing trend. Community-based interventions should be strengthened to reverse the decreasing trend of institutional delivery. Targeted information dissemination and communication should be provided to those mothers who have no formal education and attention should be given to rural residents.

The effect of lack of ANC visit and unwanted pregnancy on home child-birth in Ethiopia: a systematic review and meta-analysis

Although extensive efforts were made to improve maternal and child health, the magnitude of home child-birth is considerably high in Ethiopia. Therefore, this meta-analysis aimed to estimate the effect of lack of ANC visit and unwanted pregnancy on home child-birth among reproductive-age women in Ethiopia. International databases, including Cochrane Library, Google Scholar, PubMed, Global Health, HINARI, and CINAHL were searched systematically to identify studies reporting the prevalence of home child-birth and its association with lack of ANC visit and unwanted pregnancy among reproductive-age women in Ethiopia. STATA/SE version-14 was used to analyze the data and Der Simonian and Liard's method of random effect model was used to estimate the pooled effects. The heterogeneity between study and publication bias was assessed by using I-squared statistics and Egger's test respectively. A total of 19 studies with 25,228 study participants were included in this meta-analysis. The pooled prevalence of home child-birth among reproductive-age women in Ethiopia was 55.3%. Sever heterogeneity was exhibited among the included studies (I2 = 99.8, p = 0.000). The odds of home child-birth among mothers who have no ANC visit was 3.64 times higher compared to their counterparts [OR = 3.64, 95%, CI: (1.45, 9.13)]. There was significant heterogeneity among the included studies (I2 = 94%, p = 0.000). However, there was no statistical evidence of publication bias in the pooled effect of lack of ANC visit on home child-birth (P = 0.302). Women who experienced unwanted pregnancy were 3.02 times higher to give birth at home compared to women with a wanted pregnancy [OR = 3.02, 95%CI: (1.19, 7.67)]. Severe heterogeneity was exhibited (I2 = 93.1%, p = 0.000) but, there was no evidence of significant publication bias in the pooled effect of unwanted pregnancy on home child-birth (P = 0.832). The proportion of home child-birth among reproductive-age women in Ethiopia remains high. Lack of ANC visit and unwanted pregnancy had a significant effect on the practice of home child-birth. Strengthening behavioral change communication programs should be the primary focus area to improve institutional delivery service utilization among women with lack of ANC visit and unwanted pregnancy.

Predictors of facility-based delivery utilization in central Ethiopia: A case-control study.

BackgroundImproving access to maternal health services has been a priority for the health sector in low-income countries; the utilization of facility delivery services has remained low. Although Ethiopia provides free maternal health services in all public health facilities utilization of services has not been as expected.ObjectiveThis study examined predictors of facility delivery service utilization in central Ethiopia.MethodsWe conducted a community-based case-control study within the catchment areas of selected public health facilities in central Ethiopia. Women who delivered their last child in a health facility were considered as cases and women who delivered their last child at home were considered as controls. Data were collected using a structured questionnaire. Multivariable logistic regression analysis was used to identify independent predictors of facility delivery utilization.ResultFacility delivery was positive and strongly associated with practicing birth preparedness and complication readiness (BPCR) (AOR = 12.3, 95%CI: 3.9, 39.1); partners’ involvement about obstetric assistance (AOR = 3.1, 95%CI: 1.0, 9.0); spending 30 or less minutes to decide on the place of delivery and 45 or less minutes to walk to health facilities (AOR = 7.4, 95%CI: 2.4, 23.2 and AOR = 8.1, 95%CI: 2.5, 26.9, respectively). Additionally, having knowledge of obstetric complication, attending ≥ 4 antenatal care (ANC) visits, birth order and the use of free ambulance service also showed significant association with facility delivery.ConclusionDespite the availability of free maternal services there are still many barriers to utilization of delivery services. Strengthening efforts to bring delivery services closer to home and enhancing BPCR are necessary to increase institutional delivery service utilization.

Magnitude and Predictors of Institutional Delivery Among Mothers Who Gave Birth in the Last One Year in Nejo Rural District, West Wollega Zone, Western Ethiopia

<i>Background</i>: Globally about six out of ten births take place in health institutions. However, in Sub-Saharan African countries institutional delivery is very low. Also, in Ethiopia majority of women gave birth at home even though significant numbers of women attended antenatal care follow-up, particularly in the rural area. <i>Objective</i>: This study aimed to assess the magnitude and identify predictors of institutional delivery among mothers who gave birth in the last one year in Nejo rural district of western Ethiopia from September 1 to 30, 2019. <i>Method</i>: A community-based cross-sectional study was employed among 508 mothers who gave birth in the last one year in Nejo rural district of western Ethiopia from September 1 to 30, 2019. The data was collected using a semi-structured pretested questionnaire through face-to-face interviewing of the participants. A multistage sampling technique was used to collect data. Data were entered into Epi-Data version 3.1 and exported to SPSS version 21 for analysis. Binary logistic regression analysis was performed to assess the association between independent and dependent variables. The association was measured by odds ratio with 95% confidence interval and P-value <0.05 was used as the cut-off point to declare significance in the final model. <i>Result</i>: The magnitude of institutional delivery among mothers who gave birth in the last one year was 207 (41.4%). Mothers who attended more than secondary school [AOR=12.0; 95% CI=4.5-26.20], husbands’ occupation being government employee [AOR=6.9; 95% CI=2.2-21.5], merchants [AOR=7.6; CI=2.3-24.6] and engaged in private work [AOR=0.09; CI=0.02-0.47], ANC visits of three times & above [AOR=2.1, 95% CI=0.00-0.006], health education on maternal health [AOR=6.2, 95% 8.12-39.1] were the significant predictors of institutional delivery. <i>Conclusion</i>: The study found that institutional delivery service utilization at the study area was low, which was below the health sector transformation goal of the country which was planned to make home delivery free in which this indicator is the most important one in modeling kebeles, woredas, and finally to transform woredas. Maternal educational status, husbands’ occupation, ANC visits, and health education on maternal health were the most important predictors of institutional delivery service utilization. Hence, health planners, decision-makers, and other stakeholders should give due attention to maternal health improvement strategies in accessing health institutions for the rural community to increase institutional delivery.

Assessing practice of essential new born care and associated factors among mothers who gave birth last 6 months in east Badewacho Woreda, Hadiyya Zone, Ethiopia

Purpose: Globally, more than 2.7 million new-borns die before reaching neonatal age every year and most of the new born deaths occur at home. Half of these surprisingly occur within the first 24 h of delivery and 75% occur in the early neonatal period. Promotion of essential new-born care practice is one of a cheap approach to improve health outcomes of new-born babies. Thus, this study was aimed to assess essential new born care practice and associated factors among mothers who gave birth last 6 months in East Badewacho woreda, Hadiyya zone. Patient and methods: Community based cross sectional study design was done from March 1 to April 30, 2018. The sampled population were 399 mothers who gave live births within the last six months prior to actual data collection using multistage random sampling technique. Data was collected by using semi-structured questionnaire and entered in Epi-data version 3.1 then exported into SPSS version 21 for analysis. Binary logistic regression analysis with 95 % CI was carried out. Result: Less than half (34.1%) of the mothers were utilized essential new born care. Educational status of the husband [AOR=0.24,CI(0.089,0.64)] and [AOR=0.314,CI(0.126,0.78)], place of delivery [AOR=0.024,CI(0.009,0.068)] and knowledge on essential newborn care [AOR=2.03,CI(1.223,3.371) were significant predictors for utilization of essential newborn care. Conclusion: The study result revealed that practice of essential newborn care in East Badewacho Woreda was low. Therefore, enhance linkage of health centers with health posts to increase ANC, institutional delivery and PNC service utilization.