Determinants of Institutional Delivery Service Utilization in Ethiopia: A Systematic Review

Abstract

Background: Most obstetric complications occur unpredictably during the time of delivery, but can be prevented with proper medical care in the health facilities. Despite the Ethiopian government’s efforts to expand health service facilities and promote health institution based delivery service in the country, an estimated 85% of births still take place at home. Objective: The review was conducted with the aim of generating the best evidence on the determinants of institutional delivery service utilization in Ethiopia. Methods: Both published journals and unpublished grey literatures from 2000 to 2014 were retrieved. The reviewed studies were accessed through electronic web based search strategy from PUBMED, HINARI, Medley reference manager, Cochrane Library for systematic reviews and Google Scholar. Review Manager V5.3 Software was used for meta-analysis. Mantel-Hansel Odds ratios and their 95% confidence intervals were calculated. Heterogeneity of the study was assessed using I2test. Results: From 202 retrieved studies, only 34 studies fulfilled the preset criteria and included for the Meta analysis. Living in urban areas (OR = 13.16), primary and above educational level of the mother and husband (OR = 4.95) and (OR = 4.43) respectively, ANC visit (OR = 5.11), visiting ANC as recommended (OR = 3.24), parity one women (OR = 3.05), encountered problems during pregnancy (OR = 2.83) and distance less than 5km from nearby health facility (OR = 2.6) showed significant association with institutional delivery service utilization. Women’s autonomy was not significantly associated with institutional delivery service utilization. Conclusion and Recommendation: Residence setting, educational attainment, Parity, Antenatal care visit, frequency of Antenatal care visit, Distance to health facility and problems during pregnancy were factors positively and significantly associated with institutional delivery service utilization. Promoting couples education beyond primary, health education regarding the danger signs of pregnancy and benefit of institutional delivery through available communication networks such as health development army for uneducated and rural mother and Promotion of antenatal care visits and the completion of four standard visits by pregnant women were recommended