Determinants of Home Delivery Among Women in Rural Pastoralist Community of Hamar District, Southern Ethiopia: A Case–Control Study

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Abstract

Purpose

Studies addressing determinants of home delivery in pastoralist areas are scarce in Ethiopia. In this study, we aimed to assess determinants of home delivery in rural pastoralist communities of Hamar District, Southern Ethiopia.

Patients and Methods

In April 2018, we conducted a community-based case–control study. Of 35 rural kebeles (lowest level of administration) in the district, 8 were randomly selected. Ninety-nine randomly selected cases (mothers who gave birth at home) and 193 controls (mothers who gave birth at health facility) were included in the study. We used structured questionnaires to collect data. Through face-to-face interview, data on place of delivery, socio-demographic characteristics, obstetric history knowledge and attitude of mothers were collected. We used logistic regression model to measure association between variables.

Results

Late initiation of antenatal care (AOR = 4.6, 95% CI = 1.2, 17.1), husbands only decision-making (adjusted odds ratio [AOR] =7.2, 95% CI = 2.1, 24.5), women’s preference for traditional birth attendants (TBAs) (AOR = 3.9, 95% CI = 1.2, 12.5), and not involving in women’s development army (WDA), (AOR = 3.3, 95% CI = 1.0, 10.5) increased the risk of home delivery. Moreover, low maternal knowledge on danger signs of pregnancy (AOR = 6.5, 95% CI = 1.5, 29.0) and negative maternal attitudes towards institutional delivery (AOR = 4.4, 95% CI = 1.4, 14.1) were other factors that increased the risk of home delivery.

Conclusion

Among our study participants, a number of factors increased the risk of home delivery. Improving women’s awareness on the importance of institutional delivery, establishing systems for integration between TBAs and health facilities, empowering women and promoting them to participation in WDA were recommended.

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Why do women prefer home births in Ethiopia?

Solomon Shiferaw, Mark Spigt, Merijn Godefrooij … (2013)

Background Skilled attendants during labor, delivery, and in the early postpartum period, can prevent up to 75% or more of maternal death. However, in many developing countries, very few mothers make at least one antenatal visit and even less receive delivery care from skilled professionals. The present study reports findings from a region where key challenges related to transportation and availability of obstetric services were addressed by an ongoing project, giving a unique opportunity to understand why women might continue to prefer home delivery even when facility based delivery is available at minimal cost. Methods The study took place in Ethiopia using a mixed study design employing a cross sectional household survey among 15–49 year old women combined with in-depth interviews and focus group discussions. Results Seventy one percent of mothers received antenatal care from a health professional (doctor, health officer, nurse, or midwife) for their most recent birth in the one year preceding the survey. Overall only 16% of deliveries were assisted by health professionals, while a significant majority (78%) was attended by traditional birth attendants. The most important reasons for not seeking institutional delivery were the belief that it is not necessary (42%) and not customary (36%), followed by high cost (22%) and distance or lack of transportation (8%). The group discussions and interviews identified several reasons for the preference of traditional birth attendants over health facilities. Traditional birth attendants were seen as culturally acceptable and competent health workers. Women reported poor quality of care and previous negative experiences with health facilities. In addition, women’s low awareness on the advantages of skilled attendance at delivery, little role in making decisions (even when they want), and economic constraints during referral contribute to the low level of service utilization. Conclusions The study indicated the crucial role of proper health care provider-client communication and providing a more client centered and culturally sensitive care if utilization of existing health facilities is to be maximized. Implications of findings for maternal health programs and further research are discussed.

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Factors associated with home delivery in Bahirdar, Ethiopia: A case control study

Fantu Abebe, Yemane Berhane, Belaineh Girma (2012)

Background In Ethiopia although pregnant mothers increasingly attend antenatal clinics, utilization of skilled delivery service remains very low. The individual or health system factors that affect women’s preferences for delivery places are not well known. Method A case control study was conducted in July 2010 to assess factors associated with utilization of institutional delivery service. A total of 324 mothers who recently delivered and visited either postnatal care or sought immunization services were included. Cases (n = 108) were mothers who gave birth at home and controls (n = 216) were those who delivered at health facility. Pre-tested and standardized questionnaires were used to collect relevant data by trained data collectors. Logistic regression model was used to control for confounding. Result The likelihood of delivering at home was greater among mothers with inadequate knowledge of pregnancy related services (AOR = 62, 95% CI: 3, 128.4), those who started attending ANC after 24 weeks of gestation (AOR 8.7, 95% CI: 2.2, 33.3), mothers having no formal education (Adjusted OR 4.2, 95% CI 1.63, 11.27) and rural residents (AOR = 3.6, 95%CI: 1.4, 9.0). Conclusion The predominant factors associated with home delivery services were lack of knowledge about obstetrics care, delay in starting Antenatal Care (ANC) follow up, having, Illiteracy and rural residence. Audience specific behavioral change communication should be designed to improve the demand for delivery services. Health professionals should take the opportunity to encourage mothers attend delivery services during ANC follow up. Improvements should be made in social conditions including literacy and major social mobilization endeavors.

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Skilled birth attendant competence: an initial assessment in four countries, and implications for the Safe Motherhood movement.

S Gbangbade, M Bucagu, Barton R. Burkhalter … (2004)

Percentage of deliveries assisted by a skilled birth attendant (SBA) has become a proxy indicator for reducing maternal mortality in developing countries, but there is little data on SBA competence. Our objective was to evaluate the competence of health professionals who typically attend hospital and clinic-based births in Benin, Ecuador, Jamaica, and Rwanda. We measured competence against World Health Organization's (WHO) Integrated Management of Pregnancy and Childbirth guidelines. To evaluate knowledge, we used a 49-question multiple-choice test covering seven clinical areas. To evaluate skill, we had participants perform five different procedures on anatomical models. The 166 participants came from facilities at all levels of care in their respective countries. On average, providers answered 55.8% of the knowledge questions correctly and performed 48.2% of the skills steps correctly. Scores differed somewhat by country, provider type, and subtopic. A wide gap exists between current evidence-based standards and current levels of provider competence.

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Author and article information

Journal

Journal ID (nlm-ta): Risk Manag Healthc Policy

Journal ID (iso-abbrev): Risk Manag Healthc Policy

Journal ID (publisher-id): rmhp

Journal ID (pmc): rmhp

Title: Risk Management and Healthcare Policy

Publisher: Dove

ISSN (Electronic): 1179-1594

Publication date (Electronic): 15 October 2020

Publication date Collection: 2020

Volume: 13

Pages: 2159-2167

Affiliations

[1 ]South Nations Nationalities and Peoples Regional State Health Bureau , South Omo Zone Health Department, Jinka, Ethiopia

[2 ]Hawassa University, College of Medicine and Health Science , School of Public Health, Hawassa, Ethiopia

Author notes

Correspondence: Endrias Markos Woldesemayat Email endromark@yahoo.com

Author information

Mebratu Shite Wondimu http://orcid.org/0000-0002-8075-9361

Endrias Markos Woldesemayat http://orcid.org/0000-0003-4275-3695

Article

Publisher ID: 268977

DOI: 10.2147/RMHP.S268977

PMC ID: 7575064

PubMed ID: 33116994

SO-VID: ad8c3415-9857-44d1-8416-63c6aee3fc30

License:

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

History

Date received : 23 June 2020

Date accepted : 11 September 2020

Page count

Figures: 0, Tables: 10, References: 38, Pages: 9

Funding

Funded by: Hawassa University;

Hawassa University, Ethiopia.

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Determinants of Home Delivery Among Women in Rural Pastoralist Community of Hamar District, Southern Ethiopia: A Case–Control Study

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Most cited references 32

Why do women prefer home births in Ethiopia?

Factors associated with home delivery in Bahirdar, Ethiopia: A case control study

Skilled birth attendant competence: an initial assessment in four countries, and implications for the Safe Motherhood movement.

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