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Individual, household and contextual factors associated with skilled delivery care in Ethiopia: Evidence from Ethiopian demographic and health surveys

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  • Markos Mezmur
  • Kannan Navaneetham
  • Gobopamang Letamo
  • Hadgu Bariagaber

Abstract

Despite evidence that social contexts are key determinants of health, research into factors associated with maternal health service utilization in Ethiopia has often focused on individual and household factors. The downside is that this underestimates the importance of taking contextual factors into account when planning appropriate interventions in promoting safe motherhood in the country. The purpose of this study is to fill this knowledge gap drawing attention to the largely unexplored contextual factors affecting the uptake of skilled attendance at delivery in a nationally representative sample. Data for the study comes from two rounds of the Ethiopian Demographic and Health Surveys (EDHS) conducted in the year 2005 and 2011. Analysis was done using a two-level multivariable multilevel logistic regression model with data from 14, 242 women who had a live birth in the five years preceding the surveys clustered within 540 (in the year 2005) and 624 (in the year 2011) communities. The results of the study point to multiple levels of measured and unmeasured factors affecting the uptake of skilled delivery care in the country. At community level, place of residence, community level of female education and fertility significantly predict the uptake of skilled delivery care. At individual and household level, maternal age, birth order, maternal education, household wealth and access to media predict the uptake of such service. Thus, there is a need to consider community contexts in the design of maternal health programs and employ multi-sectorial approach to addressing barriers at different levels. For example, improving access and availability of skilled delivery care should eventually enhance the uptake of such services at community level in Ethiopia. At individual level, efforts to promote the uptake of such services should constitute targeted interventions paying special attention to the needs of the youth, the multiparous, the less educated and women in the poorest households.

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  • Markos Mezmur & Kannan Navaneetham & Gobopamang Letamo & Hadgu Bariagaber, 2017. "Individual, household and contextual factors associated with skilled delivery care in Ethiopia: Evidence from Ethiopian demographic and health surveys," PLOS ONE, Public Library of Science, vol. 12(9), pages 1-16, September.
    • Handle: RePEc:plo:pone00:0184688
    DOI: 10.1371/journal.pone.0184688
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    References listed on IDEAS

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    1. Stephenson, R. & Baschieri, A. & Clements, S. & Hennink, M. & Madise, N., 2006. "Contextual influences on the use of health facilities for childbirth in Africa," American Journal of Public Health, American Public Health Association, vol. 96(1), pages 84-93.
    2. Kruk, Margaret E. & Rockers, Peter C. & Mbaruku, Godfrey & Paczkowski, Magdalena M. & Galea, Sandro, 2010. "Community and health system factors associated with facility delivery in rural Tanzania: A multilevel analysis," Health Policy, Elsevier, vol. 97(2-3), pages 209-216, October.
    3. Gage, Anastasia J., 2007. "Barriers to the utilization of maternal health care in rural Mali," Social Science & Medicine, Elsevier, vol. 65(8), pages 1666-1682, October.
    4. McTavish, Sarah & Moore, Spencer & Harper, Sam & Lynch, John, 2010. "National female literacy, individual socio-economic status, and maternal health care use in sub-Saharan Africa," Social Science & Medicine, Elsevier, vol. 71(11), pages 1958-1963, December.
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    1. Seman K. Ousman & Jeanette H. Magnus & Johanne Sundby & Mekdes K. Gebremariam, 2020. "Uptake of Skilled Maternal Healthcare in Ethiopia: A Positive Deviance Approach," IJERPH, MDPI, vol. 17(5), pages 1-22, March.
    2. Samuel Hailegebreal & Girma Gilano & Atsedu Endale Simegn & Binyam Tariku Seboka, 2022. "Spatial variation and determinant of home delivery in Ethiopia: Spatial and mixed effect multilevel analysis based on the Ethiopian mini demographic and health survey 2019," PLOS ONE, Public Library of Science, vol. 17(3), pages 1-16, March.
    3. Mamunur Rashid & Mohammad Rocky Khan Chowdhury & Manzur Kader & Anne-Sofie Hiswåls & Gloria Macassa, 2022. "Determinants of Utilization of Institutional Delivery Services in Zambia: An Analytical Cross-Sectional Study," IJERPH, MDPI, vol. 19(5), pages 1-13, March.
    4. Tesfalidet Tekelab & Catherine Chojenta & Roger Smith & Deborah Loxton, 2019. "Factors affecting utilization of antenatal care in Ethiopia: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 14(4), pages 1-24, April.
    5. Tanvir M Huda & Morseda Chowdhury & Shams El Arifeen & Michael J Dibley, 2019. "Individual and community level factors associated with health facility delivery: A cross sectional multilevel analysis in Bangladesh," PLOS ONE, Public Library of Science, vol. 14(2), pages 1-13, February.
    6. Sanni Yaya & Ghose Bishwajit & Olalekan A Uthman & Agbessi Amouzou, 2018. "Why some women fail to give birth at health facilities: A comparative study between Ethiopia and Nigeria," PLOS ONE, Public Library of Science, vol. 13(5), pages 1-11, May.

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