Mekuria Yibeltal Addis, Zeleke Betelhem Gelaw, Mekonen Getahun Workineh, Chekol Tewabe Malede
Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
BMC Pregnancy Childbirth. 2025 Jan 22;25(1):48. doi: 10.1186/s12884-025-07164-4.
Delivery assisted by skilled birth attendants is essential for maternal and newborn health because most maternal and infant deaths occur during childbirth. Ethiopia continues to use skilled birth care services that are far below acceptable standards. There are also regional variations in skilled birth attendant delivery services in the country. Therefore, this study explored the spatial distribution and factors associated with the use of skilled birth attendants in Ethiopia based on nationally representative EMDHS 2019 data.
This study included a weighted sample of 5,527 women who had given birth within the 5 years prior to the survey year. ArcGIS version 10.7 was used to visualize the geographic variations, and Kulldorff's SaTScan version 9.6 was used to identify significant purely spatial clusters. A multilevel mixed-effects logistic regression model was fitted to identify determinant factors of skilled birth attendant delivery using STATA 17.
The number of women who delivered with the assistance of skilled birth attendants was 2,740 (49.6%) and distributed non-randomly across the regions of the country. Low clustering of skilled birth attendant delivery was detected in the Afar, Amhara, Benshangul-Gumuz, Gambela, Oromia, and Somali regions, whereas high clustering was detected in the Addis Ababa, Dire Dawa, and Harari regions. Maternal education level, parity, wealth index, region, place of residence, and community poverty level were significant predictors of skilled birth attendant delivery.
Skilled birth-assisted delivery remains below national and international acceptable standards and is associated with geographic variation across the country. If it continues at the current pace, it will be difficult to achieve national and international targets. Therefore, a geographic-specific intervention should be launched by the government and respective local administrators, supported by local research in regions with low-skilled birth attendant delivery, to tackle individual and aggregate community-level determinants.
由于大多数孕产妇和婴儿死亡发生在分娩期间，由熟练的助产人员协助分娩对孕产妇和新生儿健康至关重要。埃塞俄比亚继续使用远低于可接受标准的熟练分娩护理服务。该国熟练助产人员分娩服务也存在地区差异。因此，本研究基于具有全国代表性的2019年埃塞俄比亚疟疾和健康调查（EMDHS）数据，探讨了埃塞俄比亚熟练助产人员使用情况的空间分布及相关因素。
本研究纳入了在调查年份前5年内分娩的5527名妇女的加权样本。使用ArcGIS 10.7版本可视化地理差异，使用Kulldorff的SaTScan 9.6版本识别显著的纯空间聚类。使用STATA 17拟合多级混合效应逻辑回归模型，以确定熟练助产人员分娩的决定因素。
在熟练助产人员协助下分娩的妇女有2740名（49.6%），且在该国各地区分布不均。在阿法尔、阿姆哈拉、本尚古勒-古穆兹、甘贝拉、奥罗米亚和索马里地区，熟练助产人员分娩的聚集程度较低，而在亚的斯亚贝巴、迪雷达瓦和哈拉里地区，聚集程度较高。孕产妇教育水平、胎次、财富指数、地区、居住地点和社区贫困水平是熟练助产人员分娩的重要预测因素。
熟练助产分娩仍低于国家和国际可接受标准，且与全国地理差异相关。如果按目前的速度持续下去，将难以实现国家和国际目标。因此，政府和各地方行政人员应在熟练助产人员分娩率较低的地区进行本地研究的支持下，开展针对特定地理区域的干预措施，以解决个体和社区层面的决定因素。
