エチオピアにおける宅配の課題

タイトル: Individual and community level factors associated with home delivery after adequate antenatal care visits: a multilevel analysis of the Ethiopian Demographic and Health Survey 2019

概要: BackgroundDespite the reported increased antenatal care (ANC) utilization in Ethiopia, large numbers of women give birth at home without skilled personnel attendance, even after attending an adequate antenatal care schedule ([≥] four antenatal visits) as recommended by the World Health Organization (WHO). This study aimed to assess individual and community-level factors associated with home delivery after adequate antenatal care visits in Ethiopia. MethodsWe analyzed the 2019 Ethiopian mini demographic and health survey data. A total weighted sample of 1,643 women who had full antenatal care visits for their last childbirth/index birth was included in the analysis. Model comparison was done by using intra-cluster correlation, median odds ratio, and proportional change in variance. A multivariable multilevel logistic regression analysis was conducted to identify the effect of individual and community-level factors on the outcome variable (home delivery). Adjusted odds ratios (AOR), along with a 95% confidence interval (CI) were used to estimate the strength of the associations. ResultsThe intra cluster correlation (ICC) in the null model was 59%, showing that there was a significant difference in the prevalence of home delivery after adequate antenatal care at the community level, and the variability declined to 36.5% in the final model. Therefore, multilevel logistic regression model was utilized. At individual-level, secondary educational level was negatively associated with home delivery [AOR = 0.37; 95%CI: (0.17, 0.80)], and having a household of [≥] 5 members [AOR = 1.70; 95%CI: (1.09, 2.66)], poorest (vs. richest) wealth index [AOR = 6.98; 95%CI (2.89, 16.83)], poorer (vs. richest) wealth index [AOR = 2.77, 95%CI :(1.19,6.45)], and 2-3 birth order [AOR = 2.48; 95% CI(1.45, 4.21)] were associated with home delivery after attending the required adequate ANC visits. Community-level variables associated with home delivery after full antenatal care visits included: poor communities [AOR = 2.13; 95%CI (1.03, 4.40)], and living in a rural area [AOR = 2.74; 95%CI (1.19, 6.30)]. ConclusionThe findings of the current study indicate that in women who had the required number of ANC visits, having a larger household and poorest and poorer (vs. rich) wealth index, being the 2nd or 3rd birth, residing in a rural area, and living in poor communities were predictors of home delivery. Having a secondary education was supportive, against delivering at home. Strategies to improve households socioeconomic empowerment were recommended.