Background: Delivery by skilled birth attendance serves as an indicator of progress towards reducing maternal mortality. In Ethiopia, the proportions of births attended by skilled personnel were very low 15 % and Oromia region 14.7 %. The current study identified factors associated with utilization of institutional delivery among married women in rural area of Western Ethiopia. Methods: A community based cross-sectional study was employed from January 2 to January 31, 2015 among mothers who gave birth in the last 2 years in rural area of East Wollega Zone. A multi-stage sampling procedure was used to select 798 study participants. A pre-tested structured questionnaire was used to collect data and female high school graduates data collectors were involved in the data collection process. Bivariate and multivariable logistic regression model was fit and statistical significance was determined through a 95 % confidence level. Results: The study revealed that 39.7 % of the mothers delivered in health facilities. Age 15-24 years (AOR 4.20, 95 % CI 2.07-8.55), 25-34 years (AOR 2.21, 95 % CI 1.32-3.69), women’s educational level (AOR 2.00, 95 % CI 1.19-3.34), women’s decision making power (AOR 2.11, 95 % CI 1.54-2.89), utilization of antenatal care (ANC) during the index pregnancy (AOR 1.56, 95 % CI 1.08-2.23) and parity one (AOR 2.20, 95 % CI 1.10-4.38) showed significant positive association with utilization of institutional delivery. Conclusion and recommendation: In this study proportion of institutional delivery were low (39.7 %). Age, women’s literacy status, women’s decision making power, ANC practice and numbers of live birth were found important predictors of institutional delivery. The findings of current study highlight the importance of boosting women involvement in formal education and decision making power. Moreover since ANC is big pillar for the remaining maternal health services effort should be there to increase ANC service utilization.
A community-based cross-sectional study was carried out from January 2 to January 31, 2015 among mothers who gave birth in the last 2 years in rural area of East Wollega Zone, Oromia Region, West Ethiopia. East Wollega Zone is one of the zones of Oromia Regional state with a population of 1,230,402 among which 614,761 are males and 615,641 are females. Majority of the population live in rural areas 86 % (1,061,120). Nekemte is the capital city of the zone which is located 331 km west of Addis Ababa with a population of 76,817 (male 39,167 and female 37,650) [13]. The source population was all married women aged 15–49 years who gave at least one birth in the last 2 years preceding the survey. Study populations were randomly selected married women aged 15–49 years who gave at least one birth in the last 2 years preceding the survey. Women who were critically ill could not provide informed consent were excluded from the study. The sample size was determined using a formula for estimation of single population proportion with the assumption of 95 % confidence interval (CT), margin of error 5 % and taking 61.6 % institutional delivery prevalence of Holeta town, central Ethiopia [14] and a design effect of 2. To avoid the effect of the design that decreases the representativeness of the study we used design effect. To compensate the non-response rate, 10 % of the determined sample was added up on the calculated sample size and the final sample size was 801. A multi-stage sampling technique was employed for the selection of the sampling units. First, six districts were selected from 18 districts found in East Wollega Zone. Then 10 rural kebeles (lower administrative level) were randomly selected from a list of all kebeles found in the six districts. The calculated sample size was proportionally allocated to each kebeles based on the number of married women who gave birth in the past 2 years. Then picking a house randomly for the initial household from each kebele, the final households with married women were selected using systematic sampling from the existing sampling frame of households which were identified through census prior to data collection. Finally, eligible study subjects were interviewed from each selected households. Pre-tested structured questionnaires were adapted from different literature [3, 12, 14–18] (Additional file 1). The questionnaires were prepared in English, translated into Afan Oromo (regional language), and then retranslated back to English by people who are proficient in both languages to maintain the consistency of the questionnaires. To administer the structured questionnaires, 12 female high school graduates were selected from the study area. Training was given for 3 days about the objective, relevance of the study, confidentiality of information, respondent’s rights, informed consent and techniques of interview. Six supervisors who have second degree oversaw the data collection procedures. All field questionnaires were reviewed each night and issues that arose during data collection were addressed in morning sessions. Data were cleaned and entered into a computer using Epi-Info window version 6.5 statistical programs. The data were then exported to SPSS windows version 20.0 for further analysis. The descriptive analyses such as proportions, percentages, frequency distribution and measures of central tendency were conducted. Initially, bivariate analysis was performed between dependent variable and each of the independent variables, one at a time. Their odds ratios (OR) at 95 % CI and p-values were obtained. The findings at this stage helped us to identify important associations. Then all variables found to be significant at bivariate level (at p < 0.05) were entered into multivariate analysis using the logistic regression model to test the significance of the association. Skill birth attendant means having an accredited health professional, including a midwife, doctor, or nurse, who has been trained in the skills needed to needed to manage a normal or uncomplicated pregnancy and childbirth and to support the woman in the immediate postpartum period. Institutional delivery means women who gave birth at health facility (Hospital or health center). Home deliveries means delivery attended by non-skilled birth attendant in this study. Ethical clearance and permission was obtained from Wollega University Institutional Review Board. Permission was secured from all kebeles through a formal letter. Written informed consent was obtained from each respondent before their interview. The written informed consent was also includes study participants less than 18 years since they were married and minor mature and the consent procedure was approved by ethics committee of Wollega University. Confidentiality of individual client information was ensured by using unique identifiers for the study participants and also limiting access to respondents’ information to the principal investigator and research assistants by storing the completed questionnaires and all documents with participant information in a lockable cabinet.