Spatial variation and factors associated with home delivery after ANC visit in Ethiopia; spatial and multilevel analysis

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Abstract

Introduction

Institutional delivery is crucial to reduce maternal and neonatal mortality as well as serious morbidities. However, in Ethiopia, home delivery (attended by an unskilled birth attendant) after antenatal care (ANC) visit is highly in practice. Therefore, this study aimed to assess the spatial variation and determinants of home delivery after antenatal care visits in Ethiopia.

Method

A secondary data analysis was conducted using the 2019 mini Ethiopian demographic and health survey. A total of 2,923 women who had ANC visits were included. Spatial analysis was done by using GIS 10.7 and SaTscan 9.6. The risk areas for home delivery from GIS and spatial scan statistics results were reported. A multi-level logistic regression model was fitted using Stata14 to identify individual and community-level factors associated with home delivery after ANC visit. Finally, AOR with 95% CI and random effects were reported.

Result

Home delivery after ANC visit was spatially clustered in Ethiopia(Moran’s index = 0.52, p-value <0.01 ). The primary clusters were detected in Oromia and SNNP region (LLR = 37.48, p < 0.001 and RR = 2.30) and secondary clusters were located in Benishangul Gumuz, Amhara, Tigray and Afar (LLR = 29.45, p<0.001 and RR = 1.54). Being rural resident (AOR = 2.52; 95%CI 1.09–5.78), having no formal education (AOR = 3.19;95% CI 1.11–9.16), being in the poor (AOR = 2.20;95%CI 1.51–3.22) and middle wealth index (AOR = 2.07;95% CI 1.44–2.98), having one ANC visit (AOR = 2.64; 95% CI 1.41–4.94), and living in the agrarian region (AOR = 3.63; 95%CI 1.03–12.77) had increased the odds of home delivery after ANC visit.

Conclusion and recommendation

Home delivery after ANC visit was spatially clustered in Ethiopia. Factors like maternal education, wealth index, number of ANC visits, residency and region were significantly associated with home delivery after ANC visit. Therefore, it is better to increase the number of ANC contact by giving health education, especially for women with low levels of education and better to improve the wealth status of women. A special strategy is also vital to reduce home delivery after ANC visit in those high-risk regions.

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Most cited references 52

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The association of neighbourhood and individual social capital with consistent self-rated health: a longitudinal study in Brazilian pregnant and postpartum women

Gabriela Lamarca, Maria Leal, Aubrey Sheiham … (2013)

Background Social conditions, social relationships and neighbourhood environment, the components of social capital, are important determinants of health. The objective of this study was to investigate the association of neighbourhood and individual social capital with consistent self-rated health in women between the first trimester of pregnancy and six months postpartum. Methods A multilevel cohort study in 34 neighbourhoods was performed on 685 Brazilian women recruited at antenatal units in two cities in the State of Rio de Janeiro, Brazil. Self-rated health (SRH) was assessed in the 1st trimester of pregnancy (baseline) and six months after childbirth (follow-up). The participants were divided into two groups: 1. Good SRH – good SRH at baseline and follow-up, and, 2. Poor SRH – poor SRH at baseline and follow-up. Exploratory variables collected at baseline included neighbourhood social capital (neighbourhood-level variable), individual social capital (social support and social networks), demographic and socioeconomic characteristics, health-related behaviours and self-reported diseases. A hierarchical binomial multilevel analysis was performed to test the association between neighbourhood and individual social capital and SRH, adjusted for covariates. Results The Good SRH group reported higher scores of social support and social networks than the Poor SRH group. Although low neighbourhood social capital was associated with poor SRH in crude analysis, the association was not significant when individual socio-demographic variables were included in the model. In the final model, women reporting poor SRH both at baseline and follow-up had lower levels of social support (positive social interaction) [OR 0.82 (95% CI: 0.73-0.90)] and a lower likelihood of friendship social networks [OR 0.61 (95% CI: 0.37-0.99)] than the Good SRH group. The characteristics that remained associated with poor SRH were low level of schooling, Black and Brown ethnicity, more children, urinary infection and water plumbing outside the house. Conclusions Low individual social capital during pregnancy, considered here as social support and social network, was independently associated with poor SRH in women whereas neighbourhood social capital did not affect women’s SRH during pregnancy and the months thereafter. From pregnancy and up to six months postpartum, the effect of individual social capital explained better the consistency of SRH over time than neighbourhood social capital.

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Faeco-prevalence of Campylobacter jejuni in urban wild birds and pets in New Zealand

Vathsala Mohan (2015)

Background Greater attention has been given to Campylobacter jejuni (C. jejuni) prevalence in poultry and ruminants as they are regarded as the major contributing reservoirs of human campylobacteriosis. However, relatively little work has been done to assess the prevalence in urban wild birds and pets in New Zealand, a country with the highest campylobacteriosis notification rates. Therefore, the aim of the study was to assess the faeco-prevalence of C. jejuni in urban wild birds and pets and its temporal trend in the Manawatu region of New Zealand. Findings A repeated cross-sectional study was conducted from April 2008 to July 2009, where faecal samples were collected from 906 ducks, 835 starlings, 23 Canadian goose, 2 swans, 2 pied stilts, 498 dogs and 82 cats. The faeco-prevalence of C. jejuni was 20% in ducks, 18% in starlings, 9% in Canadian goose, 5% in dogs and 7% in cats. The faeco-prevalence of C. jejuni was relatively higher during warmer months of the year in ducks, starlings and dogs while starlings showed increased winter prevalence. No such trend could be assessed in Canadian goose, swans, pied stilts and cats as samples could not be collected for the entire study period from these species. Conclusions This study estimated the faeco-prevalence of C. jejuni in different animal species where the prevalence was relatively high during warmer months in general. However, there was relative increase in winter prevalence in starlings. The urban wild bird species and pets may be considered potential risk factors for human campylobacteriosis in New Zealand, particularly in small children.

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Economic Status, Education and Empowerment: Implications for Maternal Health Service Utilization in Developing Countries

Saifuddin Ahmed, Andreea A. Creanga, Duff Gillespie … (2010)

Background Relative to the attention given to improving the quality of and access to maternal health services, the influence of women's socio-economic situation on maternal health care use has received scant attention. The objective of this paper is to examine the relationship between women's economic, educational and empowerment status, introduced as the 3Es, and maternal health service utilization in developing countries. Methods/Principal Findings The analysis uses data from the most recent Demographic and Health Surveys conducted in 31 countries for which data on all the 3Es are available. Separate logistic regression models are fitted for modern contraceptive use, antenatal care and skilled birth attendance in relation to the three covariates of interest: economic, education and empowerment status, additionally controlling for women's age and residence. We use meta-analysis techniques to combine and summarize results from multiple countries. The 3Es are significantly associated with utilization of maternal health services. The odds of having a skilled attendant at delivery for women in the poorest wealth quintile are 94% lower than that for women in the highest wealth quintile and almost 5 times higher for women with complete primary education relative to those less educated. The likelihood of using modern contraception and attending four or more antenatal care visits are 2.01 and 2.89 times, respectively, higher for women with complete primary education than for those less educated. Women with the highest empowerment score are between 1.31 and 1.82 times more likely than those with a null empowerment score to use modern contraception, attend four or more antenatal care visits and have a skilled attendant at birth. Conclusions/Significance Efforts to expand maternal health service utilization can be accelerated by parallel investments in programs aimed at poverty eradication (MDG 1), universal primary education (MDG 2), and women's empowerment (MDG 3).

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Author and article information

Contributors

Hiwotie Getaneh Ayalew:

ORCID: https://orcid.org/0000-0002-3098-3795

Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Alemneh Mekuriaw Liyew: Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Zemenu Tadesse Tessema: Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Misganaw Gebrie Worku: Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Getayeneh Antehunegn Tesema: Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Tesfa Sewunet Alamneh: Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Achamyeleh Birhanu Teshale: Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Yigizie Yeshaw: Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Adugnaw Zeleke Alem: Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Prafulla Kumar Swain: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS One

Journal ID (publisher-id): plos

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 25 August 2022

Publication date Collection: 2022

Volume: 17

Issue: 8

Electronic Location Identifier: e0272849

Affiliations

[1 ] Department of Midwifery, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia

[2 ] Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia

[3 ] Department of Human Anatomy, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia

[4 ] Department of Human Physiology, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia

Utkal University, INDIA

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: hiwotiegeta27@ 123456gmail.com

Author information

Hiwotie Getaneh Ayalew https://orcid.org/0000-0002-3098-3795

Article

Publisher ID: PONE-D-21-33331

DOI: 10.1371/journal.pone.0272849

PMC ID: 9409554

PubMed ID: 36007083

SO-VID: 1c639d0a-cc3d-4e47-a06f-1e4d45c1451b

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 18 October 2021

Date accepted : 27 July 2022

Page count

Figures: 3, Tables: 4, Pages: 17

Funding

The authors received no specific funding for this work.

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Data Availability One can get data at the link: www.measuredhs.com after being authorized user of demographic and health survey data.

Spatial variation and factors associated with home delivery after ANC visit in Ethiopia; spatial and multilevel analysis

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Most cited references 52

The association of neighbourhood and individual social capital with consistent self-rated health: a longitudinal study in Brazilian pregnant and postpartum women

Faeco-prevalence of Campylobacter jejuni in urban wild birds and pets in New Zealand

Economic Status, Education and Empowerment: Implications for Maternal Health Service Utilization in Developing Countries

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