Background: Maternal mortality from pregnancy and childbirth remains a major public health problem. Increasing access to institutional delivery is one of the key strategies to reduce childbirth-related maternal mortality. Despite all the efforts, institutional deliveries in Ethiopia remain low. Understanding factors associated with institutional delivery is important to devise strategies to improve facility based child birth. Hence, this study assessed the prevalence of institutional delivery and associated factors to bridge the gap. Methods: A community-based cross-sectional study was employed from March-April 2020. Multi-stage sampling was employed to select 500 mothers who gave birth within the last 12 months in Mandura district, Benishangul Gumuz Region, Ethiopia. Data were collected using pre tested structured questionnaire through face-to-face interview. Logistic regression models were fitted to assess the predictors of institutional delivery. Adjusted Odds ratios with 95% CI was used to show associations and statistical significance was set at a p < 0.05. Results: This study indicated that the prevalence of institutional delivery was 28.8% CI (25–33.3%). Having a positive attitude (AOR = 9.6,95%CI:2.5–35.9), attending antenatal care (ANC) at least once (AOR = 16.1,95%CI:9.6–22), attending ANC more than three times (AOR = 17.2, 95% CI:13.5–43.8), having good knowledge (AOR = 11.1, 95%CI: 2.7–45.4), and facing complications during pregnancy (AOR = 4.04, 95%CI: 1.0–16.0) were significantly associated with institutional delivery. Conclusion: The prevalence of institutional delivery in this study was low. Positive attitude toward institutional delivery, attending ANC, having good knowledge about institutional delivery, and facing complications during pregnancy were identified predictors of institutional delivery. Strategies with a focus on increasing ANC uptake, improving mothers' knowledge, and promoting institutional delivery at the community level are critical.
A community based cross-sectional study was carried out among women who gave birth in Mandura district. Mandura is one of the districts or woredas found in the Metekel Zone of Benishangul-Gumuz Region in Ethiopia; located 546 KM from Addis Ababa. According to 2007 national survey this woreda had a total population of 40,746, of whom 21,241 were men and 19,505 were women; 45% (8776) were reproductive age groups. The district had 3 urban and 17 rural kebeles (small administrative units in the district) (16). The study was conducted from March-April 2020. All reproductive age group women residing in Mandura district were the source population where as those women who gave birth within the last 12 months in the selected kebeles of the study area were study population. Critically ill mothers who were unable to respond were excluded from the study. The sample size was determined using single population formula; n = (Zα/2)2 × P (1 – p)/d2 with the following assumptions: The proportion of institutional delivery P = 18% (17), degree of precision (d) = 0.05, 95% confidence interval, and design effect of 2. Considering 10% non-response rate, the final sample size was 500. Multi-stage sampling technique was used to select nine kebeles (three urban kebeles and six rural kebeles) in the district. The kebeles were selected by lottery method. Proportional allocation was made to give equal chance for each kebele. All eligible households from each kebele were selected by systematic random sampling. The list of households was obtained from the health post (health extension workers). If more than one eligible woman were in the selected household, only one of them was interviewed. Data were collected using a structured questionnaire through face-to-face interview. The questionnaire was prepared by reviewing various literatures (17–24). The questionnaire contains socio-demographic characteristics, health facility/service-related factors, obstetric characteristics and participants' knowledge and attitude toward institutional delivery. Four health extension workers and two Bsc midwives were recruited for data collection and supervision. A two-day training was given for data collectors and supervisors on the contents of the tools and aim of the study. The pretest was conducted on 5% of the sample (25 participants) outside the study area. Some modifications and adjustments were made to questions based on lessons obtained during the pretest. The collected data was checked daily by supervisors and principal investigators for its completeness and consistency. Refers to if the woman gave birth at were minimal facilities and skilled professionals to diagnose, manage or refer obstetric complications are available (13, 18). The woman was categorized as having good knowledge if she scored 50% and above for knowledge questions, otherwise poor knowledge (13, 18). The women was considered as having positive attitude toward institutional delivery, if she scored 50% and above on attitude questions and negative attitude if not (18). Data were entered into computer, cleaned and coded using Epi-Data 3.1, then exported to SPSS version 22 for analysis. Descriptive statistics were computed to determine the frequencies and means. Model fitness was checked using Hosmer and Lemeshow's test for goodness of fit. Binary logistic regression analysis was performed to identify predictors of institutional delivery. Variables with p < 0.25 in bivariable analysis were retained into multivariable logistic regression model and adjusted odds ratio with 95% confidence interval was used to measure strength of association. Statistical significance was set at p < 0.05. The ethical approval for the study was sought from Institutional Health Research Review Committee of Haramaya University, College of health and medical science. Voluntary, written and signed consent was obtained from study participants, from a parent and/or legal guardian for the participants under 18, and from legally authorized representatives for illiterate participants. Confidentiality was maintained and all basic rights of participants were respected.
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