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Background: Majority of deaths from obstetric complications are preventable. But every pregnant woman face risks which may not always be detected through the risk assessment approach during antenatal care (ANC). Therefore, the presence of a skilled birth attendant in every delivery is the most critical intervention in reducing maternal mortality and morbidity. In Ethiopia the proportion of births attended by skilled personnel, is very low, even for women who have access to the services. Methods: A community-based follow up study was conducted from January 17, 2012 to July 30, 2012, among 2 and 3 trimester’s pregnant women in Debre-Markos town, east Gojam Zone, Amhara Region, North West Ethiopia. Simple random sampling technique was used to get a total sample size of 422 participants. Results: A total of 393 pregnant women were included in the study. The study revealed that 292(74.3%) of the pregnant women planned to deliver in a health institution. Of these 292 pregnant women 234 (80.14%) actually delivered in a health facility. Conclusions: Preference for institutional delivery is low in the study area. Sociodemographic factors, perception about delivery complication, ANC follow up and their intentions for institutional delivery are among important predictors of institutional delivery.
A community based follow up study was conducted in Debra Markos town from January17, 2012 to July 30, 2012. Debre Markos is the capital city of East Gojam zone located about 300 km from Addis Ababa, the capital city of Ethiopia. The town is divided into 7 kebeles (the smallest administrative unit) with a population estimated to be 62,469 (Census 2007). The town has one referral hospital, three health centers, three private clinics and one family guidance association clinic (FGA). All these institutions except the private clinics and FGA provide delivery service. The study population was comprised of all pregnant women in Debre Markos, who were in their second and third trimester of pregnancy at the time of survey. Subjects were selected using simple random sampling technique from a list which included all second and third trimester pregnant women. The sample size was determined by using a single population proportion formula considering the following assumptions: magnitude of intention for institutional delivery 50%, (p = 0.5), 5% level of significance (α = 0.05). The final sample size was adjusted for none response rate of 10% and it was 422. All eligible pregnant women were initially asked about their preference regarding their place of delivery (home or health institution). These mothers were visited again after six months to check on their actual place of delivery. Data was collected through face to face interview using a structured and pre-tested questionnaire while conducting house to house survey. The data collection process had two phases. Phase I- Interview of pregnant women to assess their socio-demographic profile, preference about place of delivery and some factors associated with their choice of place for delivery. Phase II. Interview of mothers after they deliver: The pregnant women who had been interviewed in phase I were interviewed again to determine their actual place of delivery and associated factors for their choice. Data was collected by 7 accelerated midwifery students from January 17, 2012 to July 30, 2012. Two midwives from Debra Markos Hospital supervised the data collection process. Data was organized using EPI Info 2002 and exported to SPSS version 16.0 software package for analysis. Variables found significant (p–value ≤ 0.05) on bivariate analysis was included in multiple logistic regression analysis to determine the effect of various factors on the outcome variable and to control confounding effect. The results were presented in the form of tables, figures and text using frequency and summary statistics such as mean, standard deviation and percentage. These describes the study population in relation to the independent variables, like: age, education, income, age at first pregnancy, parity, any obstetric complication. Variables were categorized in the context of the constructs of the health belief model and other literature. The degree of association between the independent and dependent variables was analyzed using odds ratio with 95% confidence interval. Ethical clearance was obtained from Institutional Review Board (IRB) of University of Gondar. A letter of cooperation was written for East Gojam Health Department and Debre Markos Wereda Health Office. Finally written consent was obtained from each study pregnant woman.
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