Institutional delivery service utilization and associated factors in Ethiopia: a systematic review and META-analysis

Abstract

Background: There is wide variation in the utilization of institutional delivery service in Ethiopia. Various socioeconomic and cultural factors affect the decision where to give birth. Although there has been a growing interest in the assessment of institutional delivery service utilization and its predictors, nationally representative evidence is scarce. This study was aimed to estimate the pooled national prevalence of institutional delivery service utilization and associated factors in Ethiopia.

Methods: Studies were accessed through PubMed, Cochrane library, Web of Science, and Google Scholar. The funnel plot and Egger's regression test were used to see publication bias, and I-squared statistic was applied to check heterogeneity of studies. A weighted Dersimonian laired random effect model was applied to estimate the pooled national prevalence and the effect size of institutional delivery service utilization and associated factors.

Result: Twenty four studies were included in this review. The pooled prevalence of institutional delivery service utilization was 31% (95% Confidence interval (CI): 30, 31.2%; I² = 0.00%). Attitude towards institutional delivery (Adjusted Odd Ratio (AOR) = 2.83; 95% CI 1.35,5.92) in 3 studies, maternal age at first pregnancy (AOR = 3.59; 95% CI 2.27,5.69) in 4 studies, residence setting (AOR = 3.84; 95% CI 1.31, 11.25) in 7 studies, educational status (AOR = 2.91;95% 1.88,4.52) in 5 studies, availability of information source (AOR = 1.80;95% CI 1.16,2.78) in 6 studies, ANC follow-up (AOR = 2.57 95% CI 1.46,4.54) in 13 studies, frequency of ANC follow up (AOR = 4.04;95% CI 1.21,13.46) in 4 studies, knowledge on danger signs during pregnancy and benefits of institutional delivery (AOR = 3.04;95% CI 1.76,5.24) in 11 studies and place of birth of the elder child (AOR = 8.44;95% CI 5.75,12.39) in 4 studies were the significant predictors of institutional delivery service utilization.

Conclusion: This review found that there are several modifiable factors such as empowering women through education; promoting antenatal care to prevent home delivery; increasing awareness of women through mass media and making services more accessible would likely increase utilization of institutional delivery.

Keywords: Facility-based delivery; Skilled birth attendance; Women.

Fig. 1

Conceptual framework of factors associated with the utilization of institutional delivery services in Ethiopia

Fig. 2

Study selection process

Fig. 3

The sensitivity analysis showed the pooled proportion when the studies omitted step by step

Fig. 4

Forest plot of the Proportion of institutional delivery service utilization with corresponding 95% CIs

Fig. 5

Funnel plot for publication bias

Fig. 6

Time-trend analysis of the pooled prevalence of Institutional delivery service utilization in Ethiopia from 2011 to 2018

Fig. 7

The pooled effects of maternal attitude on Institutional delivery service utilization

Fig. 8

Association of knowledge of women’s with institutional delivery service utilization in Ethiopia, 2010–2018. Abbreviations: CI, confidence interval; df, degrees of freedom; D–L, Dersimonian and laird

Fig. 9

Association of age at first pregnancy (15-24 yrs) with institutional delivery service utilization in Ethiopia, 2010–2014.Abbreviations: CI, confidence interval; df, degrees of freedom Inverse Variance

Fig. 10

Association of age at first pregnancy (25-34 yrs) with institutional delivery service utilization in Ethiopia, 2010–2018. Abbreviations: CI, confidence interval; df, degrees of freedom; Inverse Variance

Fig. 11

Association of educational statuses (can read and write) of the women with institutional delivery service utilization in Ethiopia, 2010–2018. Abbreviations: CI, confidence interval; df, degrees of freedom;I-V,Inverse Variance

Fig. 12

Association of educational statuses (Primary school) of the women with institutional delivery service utilization in Ethiopia, 2010–2018. Abbreviations: CI, confidence interval; df, degrees of freedom; Inverse Variance

Fig. 13

Association of educational statuses (Secondary school & above) of the women with institutional delivery service utilization in Ethiopia, 2010–2018. Abbreviations: CI, confidence interval; df, degrees of freedom; I-V,inverse variance

Fig. 14

Association of Occupation of the women with institutional delivery service utilization in Ethiopia, 2010–2018. Abbreviations: CI, confidence interval; df, degrees of freedom; D–L, Dersimonian and laird

Fig. 15

Association of parity (Parity = 1) with institutional delivery service utilization in Ethiopia, 2010–2018. Abbreviations: CI, confidence interval; df, degrees of freedom;D-L, D–L, Dersimonian and laird

Fig. 16

Association of availability of information source with institutional delivery service utilization in Ethiopia, 2010–2018. Abbreviations: CI, confidence interval; df, degrees of freedom;D-L, D–L, Dersimonian and laird

Fig. 17

Association of place of residence with institutional delivery service utilization in Ethiopia, 2010–2018. Abbreviations: CI, confidence interval; df, degrees of freedom;D-L, D–L, Dersimonian and laird

Fig. 18

Association of distance to health facility with institutional delivery service utilization in Ethiopia, 2010–2018. Abbreviations: CI, confidence interval; df, degrees of freedom;D-L, D–L, Dersimonian and laird

Fig. 19

Association of ANC follow up with institutional delivery service utilization in Ethiopia, 2010–2018. Abbreviations: CI, confidence interval; df, degrees of freedom;D-L, D–L, Dersimonian and laird

Fig. 20

Association of Frequency of ANC follow up with institutional delivery service utilization in Ethiopia, 2010–2018. Abbreviations: CI, confidence interval; df, degrees of freedom;D-L, D–L, Dersimonian and laird

Fig. 21

Association of Place of birth the most recent birth of the women with institutional delivery service utilization in Ethiopia, 2010–2018. Abbreviations: CI, confidence interval; df, degrees of freedom;I-V,inverse variance

Fig. 22

Association of Presence of complication during birth preceding the most recent birth with institutional delivery service utilization in Ethiopia, 2010–2018. Abbreviations: CI, confidence interval; df, degrees of freedom;D-L, D–L, Dersimonian and laird