Shiferaw Kasiye, Tiruye Getahun, Bekele Habtamu
College of Health and Medical Sciences, School of Midwifery, Haramaya University, Harar, Ethiopia.
College of Health Sciences, Arsi University, Assela, Ethiopia.
BMC Pregnancy Childbirth. 2025 Mar 21;25(1):332. doi: 10.1186/s12884-025-07464-9.
One of the global health's top priorities is improving maternal health. There is a high maternal mortality ratio, despite its major progress in the past two decades. Many countries in Sub-Saharan Africa, including Ethiopia, have not yet reached the sustainable development goal target. The majority of women die of labor and delivery-related complications, which are preventable if they had access to maternal health service utilization, particularly institutional delivery services. The low institutional delivery services utilization in Ethiopia was related to several factors. There are literature disagreements on these predictors and systematic review and meta-analysis (SRMA) studies reported different contributing factors. Therefore, this umbrella review aimed to identify pooled predictors of institutional delivery service utilization in Ethiopia.
PubMed, Web of Science, Embase, CINAHL, Scopus, Google Scholar and Cochrane were searched for SRMA studies on the predictors of institutional delivery service utilization in Ethiopia. All SRMA studies selected for potential inclusion in the umbrella review were subjected to a rigorous, independent appraisal by two critical reviewers using the Assessment of Multiple Systematic Reviews tool. Authors selected SRMA studies and abstracted data independently, and discrepancies were resolved through discussion or a third author intervened. A random-effects meta-analysis model was used to pool estimates of the included SRMA studies. Studies' heterogeneity and risk of bias were assessed using I and Egger tests, respectively.
The umbrella review revealed that institutional delivery services utilization in Ethiopia was 24% (95% confidence interval, CI: 14 to 34). Further, women education (odds ratio, OR = 3.54, 95% CI: 3.04, 4.12), attitude of the women toward maternal and child health (MCH) service (OR = 2.20, 95% CI: 1.30, 3.74), place of residence (OR = 3.29, 95% CI: 2.02, 5.34), live less than 5 km away from the nearest health facilities (OR = 3.48, 95% CI: 2.58, 4.71) and having at least one antenatal care follow-up (OR = 3.62, 95% CI: 3.03, 4.33) were significantly associated with institutional delivery service utilization.
The proportion of pregnant women using institutional delivery services is low in Ethiopia. The findings highlight women's education, tailored intervention in the attitude of women toward maternal and child health services, supporting rural communities, improving access and availability of health facilities and promoting antenatal care (ANC) follow-up play a crucial role in enhancing facility childbirth, thereby reducing maternal and neonatal mortality and achieving sustainable development goal 3.1 and 3.2.
全球卫生的首要重点之一是改善孕产妇健康。尽管在过去二十年中取得了重大进展，但孕产妇死亡率仍然很高。包括埃塞俄比亚在内的撒哈拉以南非洲许多国家尚未实现可持续发展目标。大多数妇女死于与分娩相关的并发症，如果她们能够利用孕产妇保健服务，特别是机构分娩服务，这些并发症是可以预防的。埃塞俄比亚机构分娩服务利用率低与多种因素有关。关于这些预测因素，文献中存在分歧，系统评价和荟萃分析（SRMA）研究报告了不同的影响因素。因此，本综合性综述旨在确定埃塞俄比亚机构分娩服务利用的综合预测因素。
在PubMed、科学网、Embase、CINAHL、Scopus、谷歌学术和Cochrane中检索关于埃塞俄比亚机构分娩服务利用预测因素的SRMA研究。所有被选纳入本综合性综述的SRMA研究均由两名批判性评价者使用多重系统评价评估工具进行严格、独立的评估。作者独立选择SRMA研究并提取数据，如有分歧通过讨论解决或由第三位作者进行干预。采用随机效应荟萃分析模型汇总纳入的SRMA研究的估计值。分别使用I检验和Egger检验评估研究的异质性和偏倚风险。
综合性综述显示，埃塞俄比亚机构分娩服务利用率为24%（95%置信区间，CI：14%至34%）。此外，妇女教育程度（比值比，OR = 3.54，95% CI：3.04，4.12）、妇女对母婴健康（MCH）服务的态度（OR = 2.20，95% CI：1.30，3.74）、居住地（OR = 3.29，95% CI：2.02，5.34）、居住在距离最近医疗机构不到5公里处（OR = 3.48，95% CI：2.58，4.71）以及至少有一次产前检查随访（OR = 3.62，95% CI：3.03，4.33）与机构分娩服务利用显著相关。
埃塞俄比亚使用机构分娩服务的孕妇比例较低。研究结果表明，妇女教育、针对妇女对母婴健康服务态度的针对性干预、支持农村社区、改善医疗机构的可及性和可用性以及促进产前检查（ANC）随访在增加住院分娩方面发挥着关键作用,从而降低孕产妇和新生儿死亡率，实现可持续发展目标3.1和3.2。
