Department of Statistics, Debre Markos University, Debre Markos, Ethiopia.
Department of Public Health, Debre Markos University, Debre Markos, Ethiopia.
BMC Public Health. 2020 Jul 8;20(1):1077. doi: 10.1186/s12889-020-09125-2.
The incidence of maternal mortality remains unacceptably high in developing countries. Ethiopia has developed many strategies to reduce maternal and child mortality by encouraging institutional delivery services. However, only one-fourth of women gave birth at health facility, in the country. This, this study aimed to identify individual level factors and to assess the regional variation of institutional delivery utilization in Ethiopia.
Data were obtained from the 2016 Ethiopian demographic and health survey. In this study, a total of 7174 reproductive age women who had birth within five years were included. We fitted multilevel logistic regression model to identify significantly associated factors associated with institutional delivery. A mixture chi-square test was used to test random effects. Statistical significance was declared at p < 0.05, and we assessed the strength of association using odds ratios with 95% confidence intervals.
The level of institutional delivery was 38.9%. Women's who had focused antenatal care (FANC) visit (AOR = 3.12, 95% CI: 2.73-3.56), multiple gestations (AOR = 2.06, 95% CI: 1.32-3.21, and being urban residence (AOR = 7.18, 95% CI: 5.10-10.12) were more likely to give birth at health facility compared to its counterpart. Compared to women's without formal education, giving birth at health facility was more likely for women's who had primary education level (AOR = 1.77, 95% CI: 1.49-2.10), secondary education level (AOR = 3.79, 95% CI: 2.72-5.30), and higher education level (AOR = 5.86, 95% CI: 3.25-10.58). Furthermore, women who reside in rich (AOR = 2.39, 95% CI: 1.86-3.06) and middle (AOR = 1.66, 95% CI: 1.36-2.03) household wealth index were more likely to deliver at health facility compared to women's who reside poor household wealth index. Moreover, this study revealed that 34% of the total variation in the odds of women delivered at health institution accounted by regional level.
The level of institutional delivery in Ethiopia remains low. Context specific and tailored programs that includes educating women and improving access to ANC services has a potential to improve institutional delivery in Ethiopia.
在发展中国家，产妇死亡率仍然高得令人无法接受。埃塞俄比亚制定了许多战略，通过鼓励机构分娩服务来降低母婴死亡率。然而，该国只有四分之一的妇女在医疗机构分娩。本研究旨在确定个体层面的因素，并评估埃塞俄比亚机构分娩利用的区域差异。
数据来自 2016 年埃塞俄比亚人口与健康调查。本研究共纳入了 7174 名在五年内分娩的育龄妇女。我们采用多水平逻辑回归模型来确定与机构分娩相关的显著因素。采用混合卡方检验来检验随机效应。p<0.05 为统计学显著性，我们使用优势比及其 95%置信区间来评估关联强度。
机构分娩率为 38.9%。接受重点产前护理（FANC）就诊的妇女（AOR=3.12，95%CI：2.73-3.56）、多胎妊娠（AOR=2.06，95%CI：1.32-3.21）和城市居住（AOR=7.18，95%CI：5.10-10.12）的妇女更有可能在医疗机构分娩。与没有正规教育的妇女相比，接受过小学教育（AOR=1.77，95%CI：1.49-2.10）、中学教育（AOR=3.79，95%CI：2.72-5.30）和高等教育（AOR=5.86，95%CI：3.25-10.58）的妇女更有可能在医疗机构分娩。此外，居住在富裕（AOR=2.39，95%CI：1.86-3.06）和中等（AOR=1.66，95%CI：1.36-2.03）家庭财富指数的妇女比居住在贫穷家庭财富指数的妇女更有可能在医疗机构分娩。此外，本研究显示，埃塞俄比亚妇女在医疗机构分娩的总概率的 34%由地区层面的差异造成。
埃塞俄比亚的机构分娩率仍然较低。有针对性的、量身定制的项目，包括对妇女进行教育和改善获得 ANC 服务的机会，有可能提高埃塞俄比亚的机构分娩率。
