Determinants of institutional delivery in Sub-Saharan Africa: findings from Demographic and Health Survey (2013-2017) from nine countries.

INTRODUCTION: Institutional delivery is a major concern for a country's long-term growth. Rapid population development, analphabetism, big families, and a wider range of urban-rural health facilities have had a negative impact on institutional services in Sub-Saharan Africa (SSA) countries. The aim of this study was to look into the factors that influence women's decision to use an institutional delivery service in SSA.
METHODS: The most recent Demographic and Health Survey (DHS), which was conducted in nine countries (Senegal, Ethiopia, Malawi, Rwanda, Tanzania, Zambia, Namibia, Ghana, the Democratic Republic of Congo) was used. The service's distribution outcome (home delivery or institutional delivery) was used as an outcome predictor. Logistic regression models were used to determine the combination of delivery chances and different covariates.
RESULTS: The odds ratio of the experience of institutional delivery for women living in rural areas vs urban area was 0.44 (95% confidence interval (CI) 0.41-0.48). Primary educated women were 1.98 (95% CI 1.85-2.12) times more likely to deliver in health institutes than non-educated women, and secondary and higher educated women were 3.17 (95% CI 2.88-3.50) times more likely to deliver in health centers with facilities. Women aged 35-49 years were 1.17 (95% CI 1.05-1.29) times more likely than women aged under 24 years to give birth in health centers. The number of ANC visits: women who visited four or more times were 2.98 (95% CI 2.77-3.22) times, while women who visited three or less times were twice (OR = 2.03; 95% CI 1.88-2.18) more likely to deliver in health institutes. Distance from home to health facility were 1.18 (95% CI 1.11-1.25) times; media exposure had 1.28 (95% CI 1.20-1.36) times more likely than non-media-exposed women to delivery in health institutions.
CONCLUSIONS: Women over 24, primary education at least, urban residents, fewer children, never married (living alone), higher number of prenatal care visits, higher economic level, have a possibility of mass-media exposure and live with educated husbands are more likely to provide health care in institutions. Additionally, the distance from home to a health facility is not observed widely as a problem in the preference of place of child delivery. Therefore, due attention needs to be given to address the challenges related to narrowing the gap of urban-rural health facilities, educational level of women improvement, increasing the number of health facilities, and create awareness on the advantage of visiting and giving birth in health facilities.