Determinants of non-institutional deliveries in Malawi.

Malawi has one of the highest maternal mortality ratios in the world. One of the factors contributing to high maternal mortality is the non-use of health facilities during pregnancy and delivery. The aim of this study is to examine the factors associated with non-institutional deliveries in Malawi. Data from 2004 Malawi Demographic and Health Survey and multinomial logistic regression were used to assess the association between place of delivery and selected socio-economic factors. The study population comprised of 7,218 women, who had at least one child, aged less than five years, at the time the survey. Of these women, 58% delivered at a health facility, 29.4% delivered at home and 12.6% delivered at the home of a traditional birth attendant. Multivariate analysis indicate that region (OR = 1.29 for Central Region), place of residence (OR=0.319 for urban areas), wealth status (OR=6.289 for poor, OR=4.683 for middle), education (OR=3.823 for no education, OR=2.265 for primary education), number of prenatal visits (OR=4.732 no visits, OR=1.696 1-3 visits) and ever use of family (OR=1.29 for never used) showed significant association with non-institutional deliveries. These factors should be considered in designing strategies to improve the maternal health care system in Malawi.