Spatial clustering and determinants of home birth after at least one antenatal care visit in Ethiopia: Ethiopian demographic and health survey 2016 perspective

Abstract

Background: All pregnancies are at risk and have to be attended by skilled professionals. In Ethiopia however nearly half (45.7%) of the women were giving birth at home after antenatal care (ANC) visits in which skilled professionals were not available. Therefore, the aim of this study was to assess spatial clustering and the determinant factors of home delivery after antenatal care visits in Ethiopia.

Methods: A case control study was conducted on 2110 mothers who gave birth at home after ANC (cases), and 2510 mothers who gave birth at health institutions after attending ANC (controls), based on EDHS 2016 data. As per the recommendations of the DHS program, we weighed the data before analysis. ArcGIS 10.3 was used to show spatial pattern and SaTScan™ 9.4 to identify significant clusters. Stata 14 was used for data cleaning, weighing, and the analysis of the determinant factors. Bi variable and multi variable multilevel mixed effect logistic regression was fitted. Finally, the Log-likelihood ratio (LLR) and Relative risk with p-value of spatial scan statistics and AOR with 95% CI for significant determinant factors were reported.

Results: Home delivery after ANC was spatially clustered in Ethiopia (Moran's Index = 0.91, p-value< 0.01). Attending, 1-3 ANC visits (AOR = 1.41, 95%CI: 1.17-1.71), no information about birth preparedness plan (AOR = 2.21, 95%CI: 1.83-2.69), pregnancies wanted later (AOR = 1.55, 95%CI: 1.20, 2.06), not having health insurance (AOR = 2.16, 95% CI: 1.29, 3.62), Muslim (AOR = 1.57, 95% CI: 1.13, 2.19) and protestant (AOR = 1.72, 95%CI: 1.16, 2.42) religions were positively associated with home delivery; While being rich (AOR = 0.42, 95%CI: 0.32-0.54), middle wealth index (AOR = O.66, 95%CI: 0.51, 0.86), primary education (AOR = 0.45, 95%CI: 0.36-0.55), secondary education (AOR = 0.11, 95%CI: 0.07-0.16), above secondary education (AOR = 0.06, 95%CI: 0.03-0.11) were negatively associated.

Conclusions: Home delivery after ANC follow ups was spatially clustered. Socio-demographic, health service and pregnancy related factors determined the prevalence of home delivery after antenatal care visits. Strengthening women's education, ANC visit, giving more information about birth preparedness plan, and improving family wealth are vital to reduce home delivery after antenatal care visits.

Keywords: Antenatal care; Ethiopia; Home delivery; Spatial distribution.

Fig. 1

Flow diagram of how samples for our analysis were selected form EDHS 2016 maternal data

Fig. 2

Spatial distribution of home birth after at least one ANC visit in Ethiopia, EDHS 2016 perspective. Each dot on the map represents one enumeration area

Fig. 3

Spatial autocorrelation of home birth after at least one ANC visit in Ethiopia, EDHS 2016 perspective. Shape file of the map from ttps://africaopendata.org/dataset/ethiopia-shapefiles

Fig. 4

Hotspot analysis using getis ord G* statistics of home birth after at least one ANC visit in Ethiopia: EDHS 2016 perspective. A single dot on the map represents one enumeration Area. Shape file of the map from https://africaopendata.org/dataset/ethiopia-shapefiles

Fig. 5

Most likely clusters of home birth after at least one ANC visit with 200 Kilometer radius in Ethiopia, EDHS 2016 perspective. A single dot on the map represents one enumeration area while the circles represent most likely clusters within 200 KM radius. LLR implies log likelihood ratio. Shape file of the map from https://africaopendata.org/dataset/ethiopia-shapefiles

Fig. 6

Ordinary kriging interpolation of home birth after at least one ANC visit in Ethiopia. Shape file of the map from https://africaopendata.org/dataset/ethiopia-shapefiles