Modeling delivery care service utilization of mothers in Ethiopia

Abstract

Delivery care through access to health facilities and skilled health personnel are the main important interventions for safe motherhood. The presence of a trained health-care worker during delivery is vital in reducing maternal deaths. Delivery assisted by skilled providers is the most important proven intervention in reducing maternal mortality and one of the MDG indicators to track national effort towards safe motherhood. In Ethiopia, the proportion of births attended by a skilled health professional and delivered in a health facility has remained around 6% over the past five years. Increasing the proportion of births delivered in a health facility and under the supervision of health professionals is important to reducing health risks among mothers and children. The main objectives of this study was modeling delivery care service utilization of mothers using marginal and generalized linear mixed models as well as evaluate the determinant factors for the delivery care service utilization of mothers in Ethiopia. Data was taken from the 2011 Ethiopian demographic and health survey, which is a nationally representative survey of mothers in the 15-49 years age groups. Two model families, generalized estimating equation and alternating logistic regression models from marginal model family, and generalized linear mixed model from cluster specific model family were used for the analysis. The result showed that only 17.2% of the mothers received assistance during delivery from health professional. Alternating logistic regression model was best fits the data for population-averaged effects of the given factors on delivery service utilization than generalized estimating equation model and generalized linear mixed model with two intercepts was the best model to evaluate within and between regional heterogeneity of delivery service utilization. All the fitted models gave the same conclusion that age, place of residence, mother’s education level, religion, wealth index, birth order, partner’s education level and exposure to mass media are the most determinant factors of delivery service utilization of mothers. We conclude that education and wealth quintile have a positive association with delivery assistance where as birth order has a strong negative association with delivery service utilization.