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Maternal health service utilizations are poorly equipped, inaccessible, negligible, and not well documented in the pastoral society. This research describes a quantitative and qualitative study on the determinants of institutional delivery among pastoralists of Liben Zone with special emphasis on Filtu and Deka Suftu woredas of Somali Region, Ethiopia. The study was funded by the project “Fostering health care for refugees and pastoral communities in Somali Region, Ethiopia”. This community-based cross-sectional study was conducted during November 2015. Interviews through a questionnaire and focus group discussions were used to collect the data. Proportional to size allocation followed by systematic sampling technique was used to identify the study units. The major determinants of institutional delivery in the study area were as follows: being apparently healthy, lack of knowledge, long waiting time, poor quality services, cultural beliefs, religious misconception, partner decision, and long travel. Around one-third (133, 34.5%) of the women had visited at least once for their pregnancy. More than half (78, 58.6%) of the women had visited health facilities due to health problems and only 27 (19.9%) women had attended the recommended four antenatal care visits. Majority (268, 69.6%) of the pregnant women preferred to give birth at home. Women who attended antenatal care were two times more likely to deliver at health facilities (AOR, 95% confidence interval [CI] =2.38, 1.065–4.96). Women whose family members preferred health facilities had 14 times more probability to give birth in health institutions (AOR, 95% CI =13.79, 5.28–35.8). Women living in proximity to a health facility were 13 times more likely to give birth at health facilities than women living far away (AOR, 95% CI =13.37, 5.9–29.85). Nomadic way of life, service inaccessibility, and sociodemographic and cultural obstacles have an effect on the utilization of delivery services. Increasing access, information, education, and communication need to reach pastoral women in need.
A cross-sectional community-based quantitative and qualitative study design was used to assess the determinants of institutional delivery in Liben Zone, Somali Region, eastern Ethiopia. All women of reproductive age (15–49 years) residing in Filtu and Deka Suftu districts were the source population, and pregnant women residing in Filtu and Deka Suftu districts as permanent residents were selected as the study population. The sample size was determined using the single population proportion formula n=Z(α/2)2p(1−p)w2, where n is the sample size, z is the standard normal deviation, set at 1.96 (for 95% confidence interval [CI]), w is the desired degree of accuracy (taken as 0.05) and p is the estimate prevalence of institutional delivery (50%), and the required total sample size was 385 women. Multistage sampling method was used for the Liben Zone, which consists of six woredas. Two woredas were selected by purposive sampling technique. The calculated sample sizes (385) were proportionally allocated to each selected woreda based on its size of households. A systematic sampling technique was then used to identify the study households. In the event where there was no pregnant woman in the selected household, the next household was visited. Moreover, in cases where the selected household was closed or the eligible person was absent, two attempts were made to find the respondents. Data were collected by 15 female data collectors who were familiar with the study area and local language. A standardized structured questionnaire was developed after serious revision and investigation of existing relevant studies. The original English version of the questionnaire was translated into local language (Somali version), and then the local version was translated back into English by professionals to check its consistency. Interviewer-administered exit interview was conducted in a private and quiet room for audio privacy. Supervisors and the principal investigator monitored data collection very closely. The questionnaire was pretested in 10% of the sample size in other kebeles before the actual study and appropriate modifications were made accordingly. Highly structured four focus group discussions (FGDs) (Filtu, Malkahagar [Baladulamin], Ayinle, and Deka Suftu) were used to collect relevant data from the informants. The FGD participants were composed of different groups such as women in childbearing age, health professionals working in health institutions, traditional birth attendants, community leaders, clan leaders, religious leaders, and woreda or kebele officials in the study areas. Four FGDs were conducted in both woredas, and the participants were drawn from different groups as mentioned earlier. There were 31 group discussants and the maximum number of participants in each group were 6–8 in order to make it manageable in size. The questionnaire was pretested a week before the actual data collection time on a sampled unit in a kebele, which was not selected for the actual study, and modification was done accordingly. Data collectors and supervisors were trained by the principal investigator. During data collection, trained supervisors strictly supervised the correctness of the questionnaire and the procedure every day. The principal investigator also checked the completeness and correctness of the filled questionnaire. Data were entered using the EpiData software, version 3.02. Finally, data were cleaned before the actual analysis. The collected data were entered into a computer using the EpiData software; the data were cleaned and then exported to SPSS software, version 20 (IBM Corporation, Armonk, NY, USA) for further analysis. The frequencies and percentages were calculated for all variables that were related to the objectives of the study. Odds ratio (OR) with 95% CI was used to examine the associations between dependent and independent variables. To confirm the association, variables found to have a strong association in the bivariate analysis were transferred to a final multivariate model. Moreover, multivariate logistic regression analysis was done to control confounders and study the separate effects of the various factors associated with the intentions of pregnant women about the place of delivery. For multivariable analysis, statistical significance was considered when P-value was <0.05. The study obtained ethical clearance from the zonal and woreda administration, as well as from the woreda Health Bureau and Filtu Hospital Administration. A formal letter was submitted to all concerned bodies in the region to obtain their cooperation in facilitating the study. All interviews were conducted after obtaining a written signed informed consent from the respondents. Data were then collected by respecting the rights of the respondents by making the information provided by the respondents anonymous.
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