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Background Institutional delivery is one of the key interventions to reduce maternal death. It ensures safe birth, reduces both actual and potential complications, and decreases maternal and newborn death. However, a significant proportion of deliveries in developing countries like Ethiopia are home deliveries and are not attended by skilled birth attendants. We investigated the prevalence and determinants of home delivery in three districts in Sidama administration, Southern Ethiopia. Methods Between 15–29 October 2018, a cross sectional survey of 507 women who gave birth within the past 12 months was conducted using multi-stage sampling. Sociodemographic and childbirth related data were collected using structured, interviewer administered tools. Uni-variate and backward stepwise multivariate logistic regression models were run to assess independent predictors of home delivery. Results The response rate was 97.6% (495). In the past year, 22.8% (113), 95% confidence interval (CI) (19%, 27%) gave birth at home. Rural residence, adjusted odds ratio (aOR) = 13.68 (95%CI:4.29–43.68); no maternal education, aOR = 20.73(95%CI:6.56–65.54) or completed only elementary school, aOR = 7.62(95% CI: 2.58–22.51); unknown expected date of delivery, aOR = 1.81(95% CI: 1.03–3.18); being employed women (those working for wage and self-employed), aOR = 2.79 (95%CI:1.41–5.52) and not planning place of delivery, aOR = 26.27, (95%CI: 2.59–266.89) were independently associated with place of delivery. Conclusion The prevalence of institutional delivery in the study area has improved from the 2016 Ethiopian Demography Health Survey report of 26%. Uneducated, rural and employed women were more likely to deliver at home. Strategies should be designed to expand access to and utilization of institutional delivery services among the risky groups.
This survey was conducted at KMC implementation sites in SNNPR, which included Hawassa City Administration, Dale and Shebedino districts. Hawassa Comprehensive Specialized Hospital, Adare General Hospital, Yirgalem General Hospital, and Leku Primary Hospital served as KMC implementation centers. Hawassa is the capital city of SNNPR/Sidama Administration and it is located 275 km South of Addis Ababa, the capital of Ethiopia. Hawassa City Administration has eight sub-cities divided in 32 kebeles (the lowest administration unit in Ethiopia). The estimated total population size of Hawassa city in 2017 was 455,658 as projected from the 2007 Ethiopian national census [18]. It is estimated that there are over 10,000 deliveries taking place in Hawassa every year. There are 3 public hospitals and 12 health centers in the city. Shebedino district, the second study area is located 30km South of Hawassa city and has 32 Kebeles. Leku town is the capital of the district. There is one primary hospital, 9 health centers and 32 health posts in the district. An estimate of 121 deliveries is attended per month at Leku Primary Hospital. The total population of Dale district in 2017 was 317,246 with 11,104 expected deliveries per year (18). Yirgalem town is the capital of the district and it is located 45kms south of Hawassa City. There is one general hospital, 10 health centers and 36 health posts in the district. A community based cross-sectional survey was conducted during 15th- 20thOctober, 2018. Randomly selected women who gave birth in the last one year and residing at least 6 months in the area were included in the survey. Non-consenting mothers were excluded from the study. The sample size was calculated using Epi info 7 Statistical software for population survey. Considering 72.5% home delivery in SNNPR (EDHS 2016), 95% confidence interval (CI), margin of error of 5%, design effect of 1.5 for a cluster of 10 and 10% non-response rate, a total of 507 women were needed [3]. A multistage sampling technique was used to enroll study participants. There are 32 kebeles in Hawassa city, 35 in Dale and 32 in Shebedino districts. We selected 11 kebeles [4 kebeles from Hawassa City, representing urban households (36%); 4 from Dale and 3 from Shebedino districts, both representing rural households (64%)] using simple random sampling techniques. Households of women who gave birth during the last 12months preceding the study were identified and listed with the help of family folders available at the health posts of the selected 11 kebeles. Finally, the calculated sample size was proportionally allocated to the kebeles based on the identified number of eligible women. Women in each of the selected kebeles were randomly selected by simple random sampling technique using the list as a sampling frame. The questionnaires were first prepared in English and then translated to local languages: “Sidamu Afoo” for rural residents and “Amharic” for urban residents. Six data collectors who completed at least first degree in public health disciplines interviewed the participants. Data analysis was done using SPSS version 25. Descriptive, bivariate, and multivariate analyses were done to assess association between sociodemographic variables and place of delivery. Odds ratios and 95% CIs were computed. A backward stepwise multivariate regression model was run using variables with P-value <0.2 in the bivariate analysis, which included place of residence, age, education and occupation of women, paternal education, distance of health center from home, family size, number of ANC follow up, knowing the due date, planned place of birth and birth order. Model fitness was checked using Hosmer and Lemeshow test of goodness of fit which yielded a p-value = 0;889. Level of significance for independent associations was set at p<0.05. This study was approved by Institutional Review Board (IRB) of Hawassa University. Considering non-invasive nature of data collection procedures, which is a case in most surveys conducted in Ethiopia, a verbal consent, which was approved by the IRB, was obtained from all women participated in the survey after detailed introduction of the objectives of the study and the right to withdraw from the study at any time. The information sheet and consent was read slowly and loudly by the data collector to the participants. Then, they were asked if there were any queries. After the mothers had confirmed that all is clear, they were asked one last question if they were willing to participate in the survey or not. The data collectors circled either ‘yes’ or ‘no’ based on whichever is selected and the interview was conducted only if the data collector was told to circle the response ‘yes’. This was attached to the questionnaire and documented. Seven (1.4%) mothers were less than 18 years old, but the consent was obtained from these women since they have been married and do not live with the family. The IRB was aware of this situation and approved the verbal consent obtained from mothers less than 18 years old. Confidentiality was maintained by decoding study subjects’ identifiers and the consent form and questionnaires were kept in locked file cabinets.
