Institutional delivery and associated factors among women who gave birth in Benishangul Gumuz region, South West Ethiopia

  • Frontiers in Public Health, Volume 10, Year 2022

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Study Justification:
– Maternal mortality from pregnancy and childbirth is a significant public health issue.
– Increasing access to institutional delivery is a key strategy to reduce maternal mortality.
– Despite efforts, institutional deliveries in Ethiopia remain low.
– Understanding factors associated with institutional delivery is important to improve facility-based childbirth.
Study Highlights:
– Prevalence of institutional delivery in the study area was 28.8%.
– Factors associated with institutional delivery included positive attitude, attending antenatal care (ANC) at least once, attending ANC more than three times, good knowledge, and facing complications during pregnancy.
– Strategies to increase ANC uptake, improve mothers’ knowledge, and promote institutional delivery at the community level are critical.
Study Recommendations for Lay Reader:
– Encourage pregnant women to have a positive attitude towards institutional delivery.
– Emphasize the importance of attending ANC at least once and attending ANC more than three times.
– Promote knowledge about institutional delivery among pregnant women.
– Raise awareness about the risks and complications of pregnancy and childbirth.
Study Recommendations for Policy Maker:
– Develop and implement programs to increase ANC uptake among pregnant women.
– Strengthen healthcare facilities to provide quality ANC services.
– Conduct community-based education and awareness campaigns to improve knowledge about institutional delivery.
– Enhance access to skilled professionals and facilities for managing obstetric complications.
Key Role Players:
– Health extension workers
– Bsc midwives
– Supervisors
– Principal investigators
Cost Items for Planning Recommendations:
– Training for data collectors and supervisors
– Recruitment and payment of health extension workers and Bsc midwives
– Transportation and logistics for data collection
– Printing and distribution of educational materials
– Communication and awareness campaigns
– Strengthening healthcare facilities and services

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is a community-based cross-sectional study, which provides valuable information on the prevalence of institutional delivery and associated factors. The sample size of 500 mothers is adequate for this type of study. The data collection methods and statistical analysis are clearly described. However, the study is limited by its cross-sectional design, which only allows for associations to be identified and not causality. To improve the strength of the evidence, a longitudinal study design could be considered to establish causal relationships between the predictors and institutional delivery. Additionally, including a control group of women who did not give birth in the selected kebeles would provide a better comparison for the factors associated with institutional delivery.

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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Based on the provided information, here are some potential innovations that can be used to improve access to maternal health:

1. Mobile health (mHealth) interventions: Implementing mobile phone-based interventions, such as text messaging or mobile applications, to provide pregnant women with important health information, reminders for antenatal care visits, and guidance on when to seek institutional delivery.

2. Community health worker programs: Expanding community health worker programs to increase access to maternal health services in rural areas. Trained community health workers can provide education, counseling, and support to pregnant women, and help them navigate the healthcare system.

3. Telemedicine services: Introducing telemedicine services to enable remote consultations between pregnant women and healthcare providers. This can help address the issue of limited access to skilled professionals in remote areas, allowing women to receive timely advice and guidance during pregnancy and childbirth.

4. Transportation support: Establishing transportation support systems, such as ambulance services or transportation vouchers, to ensure that pregnant women can reach healthcare facilities quickly and safely when in need of institutional delivery.

5. Maternal waiting homes: Setting up maternal waiting homes near healthcare facilities, where pregnant women can stay during the final weeks of pregnancy. This can help ensure timely access to skilled care and reduce delays in reaching healthcare facilities during labor.

6. Financial incentives: Introducing financial incentives, such as conditional cash transfers or maternity vouchers, to encourage pregnant women to seek institutional delivery. This can help address financial barriers and increase the utilization of healthcare services.

7. Quality improvement initiatives: Implementing quality improvement initiatives in healthcare facilities to enhance the availability and quality of maternal health services. This can include training healthcare providers, improving infrastructure, and ensuring the availability of essential supplies and medications.

It is important to note that the specific context and needs of the Benishangul Gumuz region should be considered when implementing these innovations.
AI Innovations Description
Based on the study conducted in Mandura district, Benishangul Gumuz Region, Ethiopia, the following recommendations can be developed into an innovation to improve access to maternal health:

1. Increase awareness and knowledge: Develop community-based education programs to increase awareness and knowledge about the importance of institutional delivery and the benefits it provides for maternal and child health. This can be done through health education campaigns, community meetings, and the use of local media channels.

2. Strengthen antenatal care (ANC) services: Improve access to and utilization of ANC services by promoting early and regular attendance. This can be achieved by training and deploying more skilled health workers, ensuring the availability of essential supplies and equipment, and addressing any barriers that prevent women from accessing ANC services.

3. Address cultural and social barriers: Identify and address cultural and social factors that discourage women from seeking institutional delivery. This may involve engaging community leaders, religious leaders, and traditional birth attendants to promote the benefits of institutional delivery and dispel any misconceptions or fears.

4. Improve transportation infrastructure: Enhance transportation infrastructure to ensure that women can easily access health facilities for delivery. This may involve improving road networks, providing transportation subsidies or vouchers for pregnant women, and establishing emergency referral systems to quickly transport women with complications to higher-level health facilities.

5. Strengthen health facility capacity: Invest in improving the capacity of health facilities to provide quality maternal health services. This includes training and equipping health workers, ensuring the availability of essential drugs and supplies, and improving the overall infrastructure and functionality of health facilities.

6. Engage men and families: Involve men and families in decision-making processes related to maternal health. This can be done through community sensitization programs that emphasize the importance of male involvement, as well as providing support and incentives for men to accompany their partners to health facilities for delivery.

7. Monitor and evaluate progress: Establish a robust monitoring and evaluation system to track progress in improving access to institutional delivery. This will help identify gaps and challenges, and inform the development of targeted interventions to address them.

By implementing these recommendations, it is expected that access to institutional delivery will improve, leading to a reduction in childbirth-related maternal mortality and improved maternal and child health outcomes in the Benishangul Gumuz Region of Ethiopia.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Strengthen Antenatal Care (ANC) Services: Increase awareness and utilization of ANC services by promoting the benefits of regular check-ups during pregnancy. This can be done through community outreach programs, health education campaigns, and training healthcare providers to provide quality ANC services.

2. Improve Knowledge and Attitudes: Implement educational programs to improve knowledge and attitudes towards institutional delivery. This can include providing information on the importance of skilled birth attendance, the benefits of delivering in healthcare facilities, and addressing any misconceptions or cultural barriers that may discourage women from seeking institutional delivery.

3. Enhance Emergency Obstetric Care: Ensure that healthcare facilities have the necessary resources, equipment, and skilled healthcare providers to manage obstetric complications. This includes training healthcare providers in emergency obstetric care, improving referral systems, and strengthening the availability of essential obstetric drugs and supplies.

4. Community Engagement and Support: Engage community leaders, traditional birth attendants, and community health workers to promote institutional delivery and provide support to pregnant women. This can involve community mobilization activities, establishing support groups for pregnant women, and involving men in maternal health discussions.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Baseline Data Collection: Collect data on the current prevalence of institutional delivery, factors associated with institutional delivery, and the barriers faced by women in accessing maternal health services. This can be done through surveys, interviews, and review of existing data.

2. Intervention Design: Based on the identified recommendations, design an intervention plan that includes specific activities, target populations, and implementation strategies. This can involve collaboration with local stakeholders, healthcare providers, and community members.

3. Implementation of the Intervention: Implement the intervention plan, ensuring that all activities are carried out according to the designed strategies. This may involve training healthcare providers, conducting community awareness campaigns, and establishing support systems for pregnant women.

4. Data Collection after Intervention: Collect data on the impact of the intervention on access to maternal health services. This can include measuring changes in the prevalence of institutional delivery, knowledge and attitudes of pregnant women, and utilization of ANC services. Data can be collected through surveys, interviews, and monitoring of healthcare facility records.

5. Data Analysis: Analyze the collected data using appropriate statistical methods to assess the impact of the intervention. This can involve comparing pre- and post-intervention data, calculating adjusted odds ratios, and conducting statistical tests to determine the significance of the findings.

6. Evaluation and Recommendations: Evaluate the effectiveness of the intervention in improving access to maternal health services. Based on the findings, make recommendations for further improvements or modifications to the intervention plan.

By following this methodology, it is possible to simulate the impact of the recommendations on improving access to maternal health and identify effective strategies for addressing the barriers faced by women in accessing institutional delivery services.

Statistics:
Authors: 5
Identifiers:
DOI: 10.3389/fpubh.2022.965524
Research Areas:
Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Sexual and Reproductive Health, Social Determinants, Workforce
Study Countries:
Ethiopia
Study Design:
Case-Control Study, Cross Sectional Study, Grounded Theory
Study Approach:
Quantitative
Participants Gender:
Male & Female
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