Southern Ethiopian skilled birth attendant variations and maternal mortality: A multilevel study of a population-based cross-sectional household survey

Aschenaki Zerihun Kea; Bernt Lindtjørn; Achamyelesh Gebretsadik Tekle; Sven Gudmund Hinderaker

doi:10.1371/journal.pgph.0002466

Southern Ethiopian skilled birth attendant variations and maternal mortality: A multilevel study of a population-based cross-sectional household survey

PLOS Glob Public Health. 2023 Dec 27;3(12):e0002466. doi: 10.1371/journal.pgph.0002466. eCollection 2023.

Authors

Aschenaki Zerihun Kea^{1

2}, Bernt Lindtjørn^{1

2}, Achamyelesh Gebretsadik Tekle¹, Sven Gudmund Hinderaker²

Affiliations

¹ School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
² Centre for International Health, University of Bergen, Bergen, Norway.

Abstract

Studies examining skilled birth attendants (SBA) use and its correlation with maternal mortality at lower administrative levels are scarce. This study assessed the coverage and variations of SBA, the physical accessibility of health facilities for SBA, and the association of SBA with maternal mortality. A cross-sectional study using a population-based household survey was conducted in six Sidama National Regional State, southern Ethiopia districts, from July 2019 to May 2020. Women who had given birth in the past two years before the study were included. Stata 15 and ArcGIS 10.4.1 were used for data analysis. A multilevel logistic regression analysis was conducted to assess the effect of the sampling units and identify factors independently associated with SBA. The association between SBA and maternal mortality was examined using maternal mortality household survey data. A total of 3191 women who had given birth in the past two years and resided in 8880 households sampled for the associated maternal mortality household survey were interviewed. The coverage of SBA was 46.7%, with high variations in the districts. Thirty percent of SBA use was accounted for by the differences among the districts. One-third of the women travel more than two hours on foot to access the nearest hospital. Districts with low coverage of SBA and located far away from the regional referral centre had high maternal mortality. Education of the mother, occupation of the husband, pregnancy-related complications, use of antenatal care, parity, and distance to the nearest hospital and health centre were associated with the use of SBA. The coverage of SBA in the Sidama Region was low, with high variations in the districts. Low SBA use was associated with high maternal mortality. Due attention should be given to districts with low coverage of SBA and those located far away from the referral centre. Access to hospitals has to improve. All women should be encouraged to get antenatal care services.

Copyright: © 2023 Kea et al. 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.

Grants and funding

This study was funded by Grand Challenges IDRC Canada through the Liverpool School of Tropical Medicine and REACH Ethiopia, a non-profit organization. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.