Getnet Masrie, Temie Addis, Fufa Tilahun, Kumlachew Lake, Teym Abraham
Department of Epidemiology and Biostatistics, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia.
Department of Anatomy, Biomedical Sciences, Institute of Health Sciences, Dilla University, Dilla, Ethiopia.
SAGE Open Nurs. 2025 Jul 13;11:23779608251358700. doi: 10.1177/23779608251358700. eCollection 2025 Jan-Dec.
BACKGROUND: The utilization of skilled care before, during, and after childbirth can significantly reduce maternal mortality and save the lives of women and newborns. However, maternal and child mortality remain high and continue to pose a persistent challenge for low-income countries. Therefore, this study was conducted to identify individual- and community-level factors associated with institutional delivery in Ethiopia. METHODS: A cross-sectional study design with two-stage clustered sampling was employed using data from the 2016 Ethiopian Demographic and Health Survey (EDHS) to identify individual- and community-level factors associated with institutional delivery in Ethiopia. The study included 643 clusters (communities) and 7,091 women aged 15-49 years. Data were analyzed using two-level mixed-effects logistic regression to estimate the fixed effects of individual- and community-level factors and the random intercept for between-cluster variability, using R software version 3.5.3. RESULTS: In this study, over two-thirds (68%) of women gave birth at home. Institutional delivery was more likely among women with higher education, greater household wealth, frequent antenatal care attendance, and partners with secondary education. Conversely, it was less likely among women with more children and those perceiving long distances to health facilities as a barrier. At the community level, higher average education, media exposure, and recent use of health services were associated with greater institutional delivery use, while rural residence, perceived distance barriers, and regional disparities were linked to lower use. CONCLUSIONS: Both individual- and community-level factors were significantly associated with institutional delivery, in both positive and negative directions. Therefore, the Government of Ethiopia and relevant stakeholders should give due attention to the key factors identified in this study.
背景:分娩前、分娩期间及分娩后的熟练护理利用可显著降低孕产妇死亡率,并挽救妇女和新生儿的生命。然而,孕产妇和儿童死亡率仍然很高,继续给低收入国家带来持续挑战。因此,开展本研究以确定埃塞俄比亚与机构分娩相关的个人和社区层面因素。 方法:采用两阶段整群抽样的横断面研究设计,利用2016年埃塞俄比亚人口与健康调查(EDHS)的数据来确定埃塞俄比亚与机构分娩相关的个人和社区层面因素。该研究纳入了643个群组(社区)和7091名年龄在15 - 49岁的妇女。使用R软件版本3.5.3,通过两级混合效应逻辑回归分析数据,以估计个人和社区层面因素的固定效应以及群组间变异性的随机截距。 结果:在本研究中,超过三分之二(68%)的妇女在家分娩。受过高等教育、家庭财富较多、产前检查频繁以及伴侣具有中等教育程度的妇女更有可能在机构分娩。相反,子女较多以及认为距离医疗机构较远是障碍的妇女在机构分娩的可能性较小。在社区层面,平均教育水平较高、接触媒体以及近期使用过卫生服务与机构分娩使用率较高相关,而农村居住、感知到的距离障碍以及地区差异与使用率较低相关。 结论:个人和社区层面因素均与机构分娩显著相关,既有正向关联也有负向关联。因此,埃塞俄比亚政府和相关利益攸关方应适当关注本研究中确定的关键因素。
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