Gomora Degefa, Beressa Girma, Seyoum Kenbon, Tekalegn Yohannes, Sahiledengle Biniyam, Atlaw Daniel, Ejigu Neway, Kene Chala, Mesfin Telila, Mwanri Lillian
Madda Walabu University Goba Referral Hospital, Goba, Ethiopia.
Torrens University Australia, Adelaide, South Australia, Australia.
Reprod Health. 2025 Apr 7;22(1):49. doi: 10.1186/s12978-025-01970-x.
Despite Ethiopia's efforts to increase antenatal care (ANC) attendance, a significant number of women continue to deliver at home without skilled assistance, even after completing the recommended ANC visits. This study investigates the individual and community factors associated with home delivery among women who have received adequate ANC in Ethiopia.
Data from 1643 women in the 2019 Ethiopian Mini Demographic and Health Survey were analyzed. The study focused on women who completed adequate ANC visits for their most recent birth. Multivariable multilevel logistic regression was used to identify factors influencing home delivery, with adjusted odds ratios (AOR) and 95% confidence intervals (CI) for association strength.
Home delivery prevalence among women with adequate ANC (≥ 4 visits) was 25.6% (95% CI: 23.55, 27.78). Community differences significantly contributed, as intra-cluster correlation dropped from 59 to 36.5% in the final model. Factors increasing the likelihood of home delivery included larger households (≥ 5 members) [AOR = 1.70; 95% CI: (1.09, 2.66)], poorest [AOR = 6.98; 95% CI: (2.89, 16.83)] and poorer wealth statuses [AOR = 2.77; 95% CI: (1.19, 6.45)], and 2-3 birth order [AOR = 2.48; 95% CI: (1.45, 4.21)]. Secondary education reduced home delivery risk [AOR = 0.37; 95% CI: (0.17, 0.80)]. Community-level factors included rural residence [AOR = 2.74; 95% CI: (1.19, 6.30)] and poor communities [AOR = 2.13; 95% CI: (1.03, 4.40)].
Socioeconomic disparities and rural settings contribute to home delivery prevalence. Policies should prioritize education, rural health infrastructure, and economic empowerment to address these gaps.
尽管埃塞俄比亚努力提高产前检查（ANC）的就诊率，但仍有相当数量的妇女即使在完成了推荐的产前检查后，仍继续在家中分娩且没有专业人员协助。本研究调查了埃塞俄比亚接受过充分产前检查的妇女中与在家分娩相关的个人和社区因素。
分析了2019年埃塞俄比亚小型人口与健康调查中1643名妇女的数据。该研究聚焦于为其最近一次分娩完成了充分产前检查的妇女。采用多变量多层次逻辑回归来确定影响在家分娩的因素，并给出关联强度的调整优势比（AOR）和95%置信区间（CI）。
接受过充分产前检查（≥4次就诊）的妇女在家分娩的患病率为25.6%（95%CI：23.55，27.78）。社区差异有显著影响，在最终模型中，组内相关性从59%降至36.5%。增加在家分娩可能性的因素包括大家庭（≥5名成员）[AOR = 1.70；95%CI：（1.09，2.66）]、最贫困[ AOR = 6.98；95%CI：（2.89，16.83）]和较贫困的财富状况[ AOR = 2.77；95%CI：（1.19，6.45）]，以及第二或第三胎次[ AOR = 2.48；95%CI：（1.45，4.21）]。接受中等教育降低了在家分娩的风险[ AOR = 0.37；95%CI：（0.17，0.80）]。社区层面的因素包括农村居住[ AOR = 2.74；95%CI：（1.19，6.30）]和贫困社区[ AOR = 2.13；95%CI：（1.03，4.40）]。
社会经济差距和农村环境导致了在家分娩的患病率。政策应优先考虑教育、农村卫生基础设施和经济赋权，以弥补这些差距。
