Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
V
o
l.3
,
No
.4
, Dece
m
b
er
2
014
,
p
p
.
2
2
4
~
230
I
S
SN
: 225
2-8
8
0
6
2
24
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJPHS
Fa
ctor
s Asso
c
i
a
t
e
d
with Inst
itutional Delivery in Boricha
District of Sidama Zone, Southern Ethiopia
Ta
fese Ta
dele
1
, Alemu Tam
i
so
2
, T
a
riku T
a
dele
3
1
Department
of
Public Health
, Y
i
rgalem Medi
ca
l Sc
i
e
nc
e Col
l
e
g
e,
Southern
Ethio
p
ia
2
Unit of
Epid
em
iolog
y
,
Depar
t
m
e
nt of
Public
He
alth
, Col
l
eg
e of
Medicin
e
and
H
eal
th Sci
e
nc
e,
Arba Minch
University
, Eth
i
opia
3
Departement of
Intern
al Medicine, Co
lleg
e
of
M
e
dici
ne
and Health science, H
a
wassa
Unive
r
sity
, Ethiopia
Article Info
A
B
STRAC
T
Article histo
r
y:
Received Sept 20, 2014
Rev
i
sed
O
c
t 21
, 20
14
Accepted Nov 16, 2014
Ever
y
y
e
ar, 40
m
illion wom
e
n give birth
at ho
m
e
without the help of
a
skilled bir
t
h att
e
ndant. In 2011,
287,000
wom
e
n died during pregnancy
or
childbir
t
h. Almost all
these deaths
occu
r in d
e
velop
i
ng coun
tries where
m
o
thers
and children la
ck ac
ces
s
to bas
i
c healt
h
care
.
Reports
s
howed the
low util
iza
tion o
f
hea
lth f
aci
lit
y
for deliv
er
y serv
ice
in E
t
hiopi
a.
This stu
d
y
aim
e
d to
det
e
r
m
ine the
uti
liz
ation
and f
a
c
t
o
r
s influen
c
ing
institut
i
ona
l
deliv
er
y
.
Community
based
cross
sectional stud
y
was co
nducted from
Januar
y
to Februar
y
2013
/14 in Boricha
District
of Southern Ethiopia among
mothers who
gave birth in the last
1 y
ear
. Multistage sampling techn
i
ques
were used to
co
lle
ct da
ta from
546 m
o
thers. Ta
king in to
accou
n
t pla
ce of
birth for the las
t
child, only
4.9% wome
n gav
e
birth in a health facility
.
Women’s education lev
e
l (AOR=4.4 (95% CI=1.36-14.33
)), timing of
firstANC visit (
AOR= .03 (95
%
CI=0
.004 -
0.205)), women
’
s advice to
deliv
er in a he
alth fa
ci
lit
y dur
i
ng ANC (AOR = 31.15 (95
%
CI=2.02-
479.52)), women’s knowledge
of birth
r
e
lated
complications (
AOR= 12.4
(95% CI=2.67-5
7
.16)) and
decision making power (AOR=0.2 (95
%
CI=0.06-
0.82)) showed
signific
a
nt
a
ssociation wi
th
institut
i
onion
a
l
del
i
ver
y
.
Institution
a
l d
e
li
ver
y
in th
e stud
y
area w
a
s found to be ver
y
lo
w. Raising
awareness on in
stitution
a
l de
liv
er
y
to m
a
xim
i
ze
delive
r
y
s
e
rvic
e util
iz
atio
n
and strengthen
i
n
g
provision of education
and co
unseling to deliv
e
r in health
facility
during antenatal car
e v
i
sits at indiv
i
dual a
nd community
level should
be giv
e
n du
e
emphasis.
Keyword:
Factors
ass
o
ciated
In
stitu
tion
a
l d
e
liv
ery
Pre
v
alence
So
ut
he
rn
Et
hi
o
p
i
a
Copyright ©
201
4 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
Alem
u Tam
i
so,
Dep
a
rtm
e
n
t
Pub
lic Health,
C
o
l
l
e
ge
of M
e
di
ci
ne a
n
d
He
a
l
t
h
Sci
e
nces
,
Ar
ba M
i
nc
h
U
n
i
v
e
r
si
t
y
, So
ut
her
n
Et
hi
o
p
i
a
.
Em
a
il: ale
m
u
t
a
m
iso
@
yah
o
o
.
co
m
1.
INTRODUCTION
A s
ubst
a
nt
i
a
l
r
e
duct
i
o
n i
n
m
a
t
e
rnal
de
at
hs
h
a
s p
r
evi
ousl
y
b
een
not
e
d
f
r
om
5
43
0
0
0
deat
h
s
i
n
19
9
0
t
o
an estim
a
ted 287
000
by 2010, wit
h
a globa
l
rate of dec
line in the m
a
ternal
m
o
rtality
ratio of
3.1% pe
r
annum
ove
r t
h
e sam
e
peri
od
. Ne
ve
rt
hel
e
ss, t
h
i
s
rat
e
of
decl
i
n
e
w
oul
d
no
w
nee
d
t
o
do
u
b
l
e
i
n
or
der
t
o
ac
hi
e
v
e t
h
e
MDG targ
et
of red
u
c
i
n
g th
e
matern
al
m
o
rtality ratio
b
y
three qu
arters
b
e
tween 199
0 and 20
15
[1
].
App
r
op
riate
deliv
ery care is cru
c
ial
for
b
o
th
m
a
tern
al an
d
p
e
rin
a
tal
h
e
alth
and
in
creasin
g
sk
illed
atten
d
a
nce at
birth
is a cen
t
ral go
al
o
f
th
e safe m
o
th
erho
od
an
d ch
ild
su
rv
i
v
al m
o
v
e
m
e
n
t
s. Sk
illed
attendan
ce
at d
e
liv
ery is
an
im
p
o
r
tan
t
i
n
d
i
cator i
n
mo
n
itoring
p
r
ogress toward
s
Millen
n
i
u
m
Dev
e
lop
m
en
t Go
al 5
t
o
redu
ce t
h
e m
a
t
e
rn
al m
o
rtality
ratio
b
y
three
q
u
a
rters
b
e
t
w
een
1
990
an
d 20
15
[2
].
WHO d
e
fi
n
itio
n of sk
illed
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Fa
cto
r
s Asso
ci
a
t
ed
with In
stitu
tio
na
l
Delivery in
Bo
richa
District o
f
S
i
da
ma
Zon
e
.... (Ta
f
ese Ta
d
e
le)
22
5
atten
d
a
n
t
is a h
ealth
p
r
ov
ider who
h
a
s at
least th
e m
i
n
i
m
u
m
k
n
o
wled
g
e
and
sk
ills to
m
a
n
a
g
e
no
rm
al
chi
l
dbi
rt
h
a
n
d pr
o
v
i
d
e basi
c (
f
i
r
st
l
i
n
e)
em
ergency obstetric
care [3].
Ev
ery year, 40
m
i
l
lio
n
wo
m
e
n
g
i
v
e
b
i
rth
at
h
o
m
e with
ou
t
th
e h
e
l
p
of a
sk
illed
b
i
rt
h
at
ten
d
a
n
t
. In
2011, 287,000
wom
e
n
die
d
during pr
e
g
na
ncy or chil
dbi
rth, a
n
d 6.9 m
illion children died
before reaching
their
fifth
birt
h
d
ay
.
Alm
o
st all thes
e deat
hs
occu
r
i
n
dev
e
l
opi
ng
c
o
u
n
t
r
ies wh
ere m
o
th
ers an
d ch
ild
ren lack
access
to basic health
ca
re [4].
Acco
r
d
i
n
g t
o
EDH
S
2
0
11 a
n
o
v
er
w
h
el
m
i
n
g
m
a
jori
t
y
of
bi
rt
hs
(
90 %
)
i
n
t
h
e fi
ve y
ear
s bef
o
re t
h
e
su
rv
ey were
deliv
ered
at
home; ten
p
e
rcent o
f
b
i
rths we
re d
e
liv
ered
i
n
a h
ealth
facilit
y [5
].
In
on
e
su
rv
ey
con
d
u
ct
ed i
n
t
h
e f
o
ur
regi
ons
of Et
hi
o
p
i
a
,
9
1
%
of
wom
e
n wi
t
h
chi
l
d
re
n 0
-
1
1
m
ont
hs
of
age re
p
o
rt
e
d
t
h
at
t
h
ey
d
e
liv
ered
th
eir last ch
ild
at h
o
m
e
.
The survey also showe
d
ve
ry low pr
evalence of professi
onally as
sisted
d
e
liv
ery in all th
e fo
ur reg
i
ons at 8
%
—24
% in
Tigray
,
9
%
i
n
O
r
om
iy
a and
S
NNPR
,
and a
s
l
o
w as
4% i
n
A
m
h
a
r
a
[6
].
An
ot
he
r st
u
d
y
do
ne i
n
Et
hi
opi
a s
h
ows
,
1
6
%
of
del
i
v
eri
e
s were a
ssi
st
ed by
heal
t
h
pr
ofe
ssi
o
n
al
s,
wh
ile a sign
ifi
can
t m
a
j
o
rity (7
8%)
was atten
d
e
d
b
y
tr
adi
t
i
onal
bi
rt
h at
t
e
nda
nt
s. T
h
e m
o
st
i
m
port
a
nt
r
easo
n
s
for not seeking institutional
delivery were the belief that it
is not n
ecessa
ry (42%
) and not custom
ary (36%),
fol
l
o
we
d
by
hi
gh
co
st
(
2
2
%
)
and
di
st
a
n
ce
or
l
ack
of
t
r
an
sp
ort
a
t
i
o
n (
8
%
)
[
7
]
.
A st
u
d
y
do
ne
i
n
No
rt
h
W
e
st
of Et
hi
o
p
i
a
t
h
e com
m
on reaso
n
s f
o
r
hom
e del
i
v
ery
were cl
ose
r
atten
tio
n
fro
m
fam
i
ly
me
m
b
e
r
s and
relativ
es (60
.
9
%
),
home d
e
liv
ery is
u
s
u
a
l pr
actice (57.7%),
une
xpected
l
a
bo
ur
(3
3.
4%
)
,
n
o
t
bei
n
g si
c
k
o
r
no
pr
o
b
l
e
m
at
t
h
e t
i
m
e
of
del
i
v
ery
(2
1
.
6%
) an
d
fam
ily
i
n
fl
ue
nce (
1
4.
4%
)
[8]
.
Th
e EDHS
201
1 repo
rt showed th
e l
o
w utilizat
io
n
o
f
h
e
alth
facility for de
liv
ery service wh
ich
is
onl
y
6.
2% i
n
S
N
N
P
R
and
20
11 a
n
n
u
al
re
po
rt
of Si
dam
a
zone
heal
t
h
de
p
a
rt
m
e
nt
was 4.3% [
5
]
,
[
9
]
.
Th
eref
or
e
,
th
is stud
y aimed
to d
e
term
in
e th
e
u
tilizatio
n
an
d id
en
tif
y
th
e fact
o
r
s in
fl
u
e
n
c
i
n
g use
o
f
d
e
liv
ery serv
i
ce in
h
ealth
facility
b
y
wo
m
e
n
i
n
th
e stud
y area with
th
e
v
i
ew to
pro
pose ap
propriate in
terv
en
tio
n
at th
e
co
mm
u
n
ity an
d
facility lev
e
l to
im
p
r
o
v
e
d
e
li
v
e
ry serv
ice u
t
ilizatio
n
.
2.
R
E
SEARC
H M
ETHOD
Stud
y design
:
A
com
m
uni
t
y
-base
d
cr
oss
s
ect
i
onal
st
udy
was co
nd
uct
e
d
from
January
t
o
Febr
ua
r
y
20
1
3
/
1
4 am
ong al
l
wom
e
n of
chi
l
dbea
r
i
n
g age (
15
– 4
9
y
ears)
wh
o ga
ve
at
l
east
one bi
r
t
h i
n
t
h
e l
a
st
one y
ear
p
r
eced
i
ng
t
h
e stu
d
y
in Boricha District, Sou
t
h
e
rn
Na
tion
and
Natio
n
a
lity Peo
p
l
e Reg
i
on
al
State, Eth
i
o
p
i
a.
Sample siz
e
and s
a
mpling
techniques
: T
h
e sam
p
le size
was calculated for
pre
v
alence
of
delive
r
y
in
h
ealth
facilities an
d
th
e
facto
r
s affecting in
stitu
ti
o
n
a
l
deliv
ery. Howev
e
r, th
e sam
p
le size calcu
lated
b
y
usi
n
g t
h
e
fact
ors
was
sm
aller t
h
a
n
t
h
e
sa
m
p
l
e
si
ze obt
ai
ned
by
u
s
i
n
g
t
h
e p
r
eval
e
n
ce
of
del
i
v
e
r
y
i
n
heal
t
h
facilities. Th
erefore th
e sam
p
le size ob
tain
ed
b
y
u
s
i
n
g
single
p
opu
latio
n
propo
rtion
was u
s
ed
,wh
i
ch
was
54
6.
Th
e m
u
ltistag
e
and
sim
p
le ran
d
o
m
sa
m
p
lin
g
techn
i
qu
es
were used. Th
e
District h
a
s
one u
r
b
a
n
an
d
eig
h
t
rural su
b-lo
calities. Th
e u
r
b
a
n
sub
-
l
o
cality h
a
s th
re
e k
e
b
e
les an
d each
rural su
b-lo
cality h
a
v
e
fo
ur t
o
fiv
e
k
e
b
e
les.
Th
erefo
r
e one k
e
b
e
les from
u
r
b
a
n
and
th
ree sub
-
localities fro
m
th
e rural were selected
r
a
ndo
m
l
y to
inclu
d
e
i
n
the stud
y.
First, a
census
was
conducte
d i
n
the
selected
ke
be
les. The elig
ib
le
po
pulatio
n
was i
d
en
tified
and
a
sam
p
lin
g
frame wh
ich
en
lists all elig
ib
le stu
d
y
sub
j
ects
wa
s pre
p
a
r
ed. Then study pa
rticipants
were sel
ected
from
the sam
p
ling
fram
e
using sim
p
le random
sa
m
p
ling
proportional t
o
population size
of each ke
bele.
Stud
y p
o
p
u
lation:
Al
l
w
o
m
e
n o
f
re
p
r
o
d
u
ct
i
v
e age
w
ho
ga
ve
b
i
rth
with
in th
e last o
n
e
y
ear in
th
e
ho
use
h
ol
d
wer
e
gi
ve
n e
qual
chance
o
f
bei
n
g
i
n
cl
u
d
e
d
i
n
t
h
e st
u
d
y
,
a
n
d
one
w
o
m
a
n of
re
pr
o
duct
i
ve a
g
e
sam
p
led
b
y
th
e lo
ttery m
e
th
o
d
was i
n
clud
ed
i
n
th
e stud
y.
Data collecti
o
n
: To
m
a
in
tain
th
e qu
ality o
f
d
a
ta, th
e
qu
estio
nn
aire
was adap
ted
fro
m
p
r
ev
iou
s
st
u
d
y
and
pre-tested
in the adjace
nt
kebeles a
n
d necessary
ad
j
u
st
m
e
nt
s were m
a
de. Te
n
heal
t
h
ext
e
nsi
o
n
w
o
r
k
er
s
fr
om
ot
her ke
b
e
l
e
s wh
o
were
fl
ue
nt
i
n
t
h
e l
o
cal
l
a
ng
uage a
nd
fi
ft
een
com
m
uni
t
y
heal
t
h
pr
om
ot
ers fr
o
m
t
h
ei
r
own ke
bele wi
th the role of gui
de collected the data.
Fac
e
to face interview technique was used in
order to
collect the
data.
Each que
st
i
o
n
n
ai
re was
c
h
ec
ked
vi
s
u
al
l
y
fo
r
com
p
l
e
t
e
ness
.
The dat
a
was
ent
e
re
d usi
n
g EPI IN
FO
versi
on
3.
5.
1 and e
x
p
o
r
t
e
d t
o
SPS
S versi
o
n 1
6
.
0
fo
r dat
a
cl
eani
ng an
d anal
y
s
i
s
. Af
t
e
r dat
a
was ent
e
r
e
d
cleaning wa
s
done
by
going
back to th
e ha
rd
copies of
t
h
e questionnaire
s
.
Dat
a
pro
cessi
n
g
an
d an
al
ysi
s
:
The
data wa
s
cleaned t
o
c
h
e
c
k for its com
p
leteness,
co
ns
i
s
t
e
ncy
an
d t
h
e
pre
s
ence
o
f
m
i
ssed
val
u
es
an
d v
a
riab
les. An
y error iden
tified
was c
o
rrected as
ne
cessary. T
h
e
n
, it was ente
re
d int
o
a
pre
-
designe
d
fo
rm
at i
n
Epi
-
i
n
f
o
ve
rsi
o
n 3
.
5
.
1 an
d t
r
a
n
sfe
r
r
e
d t
o
SPS
S ve
r
s
i
on
16 f
o
r fu
rt
her a
n
al
y
s
i
s
. Freq
ue
ncy
,
m
e
an an
d
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJPHS Vol. 3, No. 4, D
ecem
ber 2014
:
224 – 230
22
6
stan
d
a
rd d
e
v
i
atio
n
were d
o
n
e
.
Bin
a
ry
Lo
g
i
stic regression
Mo
d
e
l
was fitte
d
.
First
b
i
v
a
ri
ate an
alysis between
in
d
e
p
e
nd
en
t an
d d
e
p
e
nd
en
t
v
a
riab
les
was don
e, t
h
en
all in
d
e
p
e
nd
en
t variab
les th
at sh
owed
st
atistical
significa
nce with a p-val
u
e <0.2 in
th
e b
i
v
a
riate an
alysis was in
clud
ed
in
th
e m
u
lt
i
v
ariate m
o
d
e
l. Th
o
s
e
d
e
term
in
an
t wi
th
p
-
v
a
lu
e <0.0
5, i
n
th
e m
u
lt
iv
ariate an
al
y
s
i
s
,
were
co
nsi
d
ered
as i
nde
pe
nde
nt
a
n
d si
gn
i
f
i
cant
facto
r
s
asso
ciated
with
in
stitu
tio
n
a
l d
e
liv
ery.
Ethical c
o
nsi
d
eration:
T
h
i
s
st
u
d
y
p
r
ot
o
c
ol
was
re
vi
e
w
ed
an
d a
p
pr
ove
d
by
t
h
e
re
search
an
d
p
u
b
licatio
n
o
ffice o
f
HU Scho
o
l
o
f
p
u
b
lic an
d
Env
i
ro
n
m
en
tal Health
and Add
i
s con
tin
en
tal In
stitu
te of p
u
b
lic
heal
t
h
.
Perm
i
ssi
on
t
o
ca
rry
o
u
t
t
h
e
st
u
d
y
w
a
s al
so
g
r
ant
e
d
fr
om
Si
dam
a
zone
he
al
t
h
de
part
m
e
nt
. I
ndi
vi
d
u
al
i
n
f
o
rm
ed ver
b
al
conse
n
t
was
obt
ai
ned a
f
t
e
r
bri
e
f
ex
pl
anat
i
on
o
f
t
h
e
p
u
r
p
ose a
n
d
be
nefi
t
s
of
t
h
e st
udy
t
o
eac
h
resp
o
nde
nt
.
3.
RESULT A
N
D
AN
ALY
S
IS
3.
1.
Socio dem
o
gr
aphic c
h
ar
ac
terstics
A to
tal o
f
54
6 wo
m
e
n
wh
o
g
a
v
e
b
i
rth
wit
h
in
on
e year prio
r to
th
e su
rv
ey were in
terv
iewed
.
Their
ages
range
d
from
15 to
44 years wit
h
m
ean and standard
deviation a
g
e
of 28.34
4.
7
4
.
Al
m
o
st
t
h
ree qu
a
r
t
e
rs
(7
2%
) of
t
h
e resp
o
nde
nt
s h
a
d neve
r bee
n
t
o
sc
h
ool
a
n
d of
t
h
ose w
h
o rep
o
rt
e
d
t
o
have
at
t
e
n
d
ed
f
o
rm
al
sch
ool
s;
al
m
o
st
few (
2
0.
1%)
rep
o
rt
e
d
o
n
l
y
seve
n y
ears
of
sch
ool
i
n
g. M
a
jo
r
occu
pat
i
o
n o
f
re
sp
o
nde
n
t
s was
ho
use
w
i
f
e, acc
ou
nt
i
n
g fo
r 9
9
.
6% o
f
t
h
e res
p
o
n
d
ent
s
. Al
l
of t
h
em
(100
%) were m
a
rri
ed. The
hi
g
h
es
t
pari
t
y
was
ni
ne
(Ta
b
l
e
1
)
.
Tabl
e
1.
Soci
o-
dem
ogra
phi
c c
h
aract
eri
s
t
i
c
s
o
f
t
h
e
res
p
on
de
nt
s w
h
o
ga
ve
b
i
rt
h i
n
1
y
ear
p
e
ri
o
d
i
n
Bo
r
i
ch
awo
r
ed
a, Eth
i
o
p
i
a, 2013
/14
(
N
= 546
)
3.
2.
Repr
oduc
ti
ve
char
actersi
c
s
Two
hun
dr
ed
t
h
ir
teen (3
9%)
o
f
t
h
e
r
e
spon
den
t
s h
a
v
e
atte
nded ante
natal care (ANC) at l
east onc
e in
their gestation
perio
d
. (Ta
b
l
e
2) Ve
ry
few
,
(4.
9
%
)
o
f
resp
ond
en
ts repo
rted
to
h
a
v
e
d
e
liv
ered
in
a h
ealth
facility in their m
o
st recent
delivery. Of t
h
ese, twe
n
ty
four
(4.4%) de
livered in
heal
th ce
nters a
nd three
(0
.5%
)
del
i
v
er
ed
i
n
a h
o
s
p
i
t
a
l
.
Am
ong w
o
m
e
n
wh
o del
i
v
ere
d
at
hom
e,
3
2
.
4
% were assi
st
ed
by
un
t
r
ai
ne
d
n
e
igh
bors,
3
7
.8
% were assisted
b
y
relativ
es, 16
.8
% we
re assisted
b
y
Trad
ition
a
l
Birth
Attend
an
ts (TBA's)
whi
l
e
12
.1
%
w
e
re assi
st
ed
by
hus
ba
n
d
'
s
m
o
t
h
er
an
d t
h
e re
st 0
.8
% w
e
re
Se
lf assisted
birt
h
s
(Ta
b
le.
2
).
Variable
s
Fre
q
u
e
ncy
Pe
rcent
(
%
)
Ag
e
i
n
y
e
a
r
s
15-
19
5
0.
9
20-
24
124
22.
7
25-
29
205
37.
5
30-
34
144
26.
4
35-
39
64
11.
7
40-
44
4
0.
7
Mean
SD
28.
34+
4.
74
Maternal
education
Illiterat
e
and only
able to read and w
r
ite
393
72.0
Gr
ade 1-
6
110
20.
1
Gr
ade 7-
10
43
7.
9
Husband’
s highest
educational level
Illiterat
e
and able t
o
read and writ
e
312
57.1
Gr
ade 1-
6
155
28.
4
Gr
ade 7-
8
66
12.
2
Gr
ade 9-
12
9
1.
6
T
E
V
T
/
Pr
epar
atory 4
0.
7
Re
s
ponde
nts
'
m
onthly
i
nc
om
e
<500
363
66.
5
501-
10
00
167
30.
5
1001-
1
500
8
1.
5
>=1501
8
1.
5
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Fa
cto
r
s Asso
ci
a
t
ed
with In
stitu
tio
na
l
Delivery in
Bo
richa
District o
f
S
i
da
ma
Zon
e
.... (Ta
f
ese Ta
d
e
le)
22
7
Tabl
e
2. R
e
pr
o
duct
i
v
e
he
al
t
h
pract
i
ces am
on
g
wom
e
n w
h
o
gave
bi
rt
h i
n
1
y
ear pe
ri
o
d
i
n
B
o
ri
cha
w
ore
d
a
,
Eth
i
op
ia,
2
013/1
4
.
(N
=54
6
)
Va
r
i
a
b
le
s
Fr
e
que
ncy
Pe
r
c
e
n
t
(
%
)
Wo
m
e
n
who have received ANC
213
39.0
Setting in which deliver
y
was conducted
Health center
24
4.
4
Hospital 3
0.
5
At ho
m
e
519
95.
1
Birth assistance at
ho
m
e
T
B
A 87
16.
8
Neighbor
s
168
32.
4
Husband's m
o
ther
63
12.
1
Relatives 197
37.
9
Self assisted
4
0.
8
3.
3.
Preva
l
ence o
f
institutio
na
l
deliv
ery
Maj
o
rity (9
7.3%) of th
e respo
n
d
e
n
t
s rep
o
rted
th
at
th
ey kno
w t
h
e av
ailabilit
y o
f
d
e
liv
ery serv
ice i
n
h
ealth
i
n
stitu
tio
n
s
. Th
e
reason
s
g
i
v
e
n
for
not g
e
ttin
g d
e
liv
ery serv
ice
fro
m
h
ealth in
stitu
tio
n were m
o
re t
h
an a
qua
rt
er
50
5 (
9
7.
3%)
resp
o
n
d
e
nt
s rep
o
r
t
e
d l
a
bo
r i
s
sh
ort
a
nd ease
fo
r t
h
e
m
, 14 (
2
.
7
%)
wom
e
n m
e
nt
i
o
ned t
h
at
th
ey d
i
d
n
’t kno
w th
e av
ailab
ility o
f
in
stit
u
tio
n
a
l
d
e
liv
ery serv
ice in
health
facility a
n
d
v
e
ry few 9(1.7
%
)
wo
m
e
n
rev
ealed
th
at
h
ealth institu
tio
n
is t
o
o
far t
o
u
tilize d
e
liv
ery serv
ice.
From
those who delive
r
ed at
hom
e three hundre
d
se
ve
nty four
(68.5%
) wom
e
n ga
ve birth at a place
whe
r
e t
h
ey
pl
a
nne
d a
h
ea
d.
O
f
t
h
e t
o
t
a
l
resp
on
de
nt
s m
o
re t
h
an
hal
f
3
3
5
(
61
.4
%)
wom
e
n re
veal
ed
t
h
at
t
h
ey
p
r
efer to
g
i
v
e
b
i
rth
at ho
m
e
a
n
d
on
ly 2
1
1
(
38
.6
%)
wo
m
e
n
p
r
efer to
d
e
liver in
h
ealth
facilit
y with
sk
illed
b
i
rt
h
atten
d
a
n
t
. Almo
st all 6
1
.4%
o
f
t
h
e respo
nden
t
s rev
ealed
t
h
at th
ey will hav
e
care
fro
m
fam
i
lies d
u
r
ing
ch
il
d
bi
rt
h
.
3.
4.
Fact
ors
as
soci
ate
d
w
i
th i
n
s
t
i
t
uti
o
n
a
l
del
i
v
e
r
y
Th
e v
a
riou
s facto
r
s asso
ciated
with
u
tilizati
o
n
o
f
institu
tio
n
a
l d
e
liv
ery serv
i
ces are shown
o
n
tab
l
e 3.
In t
h
e bi
vari
at
e anal
y
s
i
s
;
wo
m
e
n’s a
g
e,
wo
m
e
n’s e
ducat
i
o
n
,
w
o
m
e
n’s
pri
o
r
hi
st
o
r
y
o
f
ab
ort
i
on
, t
h
e
i
nde
x
p
r
egn
a
n
c
y
b
e
i
n
g p
l
an
n
e
d
,
timin
g
of
ANC
first
v
i
sit, women
’
s ad
v
i
ce t
o
d
e
liv
er in
h
e
alth
in
stitu
tio
n du
ri
n
g
ANC
,
w
o
m
e
n’s kn
o
w
l
e
d
g
e
of
bi
rt
h
rel
a
t
e
d com
p
l
i
cat
i
ons a
nd
deci
si
o
n
m
a
ki
ng p
o
w
er we
re si
g
n
i
f
i
cant
l
y
asso
ciated
with
u
tilizatio
n
o
f
d
e
liv
ery serv
i
ce. Yo
ung
er
wo
m
e
n
were
0
.
10
6
tim
es
m
o
re lik
ely to
u
tilize h
ealth
in
stitu
tio
n
du
ri
n
g
labo
ur
and
d
e
liv
ery un
lik
e
th
e o
l
d
e
r wo
m
e
n
.
The
relations
hip bet
w
een pl
ace of
delivery and wom
e
n’s education s
h
ows
that t
h
e
use of
health
facilities in
creases with
an
i
n
crease in
t
h
e edu
catio
n
a
l l
e
v
e
l of
wo
m
e
n
.
It is rev
eal
ed
th
at
wo
m
e
n
with
prim
ary school
educational level were alm
o
st twice as lik
ely to use form
al health
facilities for thei
r pl
ace of
d
e
liv
ery as
women
with
illite
rate and
on
ly ab
le to
read
an
d
write. On
th
e o
t
h
e
r
h
a
n
d
, tab
l
e 4
sh
owed
th
at
years sp
en
t in sch
o
o
l
sh
owed
a sig
n
i
fican
t
asso
ciatio
n
with
seek
ing
o
f
sk
illed
care du
ri
n
g
d
e
li
v
e
ry
fro
m
h
ealth
in
stitu
tio
n
w
ith
wo
m
e
n
wh
o
h
a
v
e
edu
catio
n
a
l attain
m
e
n
t
o
f
g
r
ade 7
-
1
0
h
a
v
i
n
g
a h
i
g
h
e
r proportio
n
o
f
d
e
liv
eries (27
.
9
%
)
atten
d
e
d
b
y
sk
illed
p
e
rso
n
n
e
l
in
h
ea
lth
facility co
mp
ared
to
t
h
ose with
fewer sch
o
o
ling
y
ears o
r
t
hose
wh
o
di
d
n
o
t
go
t
o
fo
rm
al
scho
ol
i
n
g
.
Wo
m
e
n
who
giv
e
h
i
gh
v
a
lu
e to
th
e ex
p
ected
ch
ild
m
a
y
b
e
m
o
re lik
ely
t
o
u
tilize h
ealt
h
facility a
t
del
i
v
ery
t
h
an
t
hos
e wi
t
h
un
w
a
nt
ed
p
r
eg
na
nc
i
e
s (OR
.
9.
64
(
9
5
%
C
I
=
2
.
2
6-
41
.1
3
)).
Wo
m
e
n
who
started
ANC clin
ic late wereless lik
ely u
tiliz
ed
h
e
alth
in
stitu
tio
n
du
ri
n
g
deliv
ery to
b
e
assisted
b
y
a sk
illed
atten
d
a
n
t
co
m
p
ared
to tho
s
e
who
started
ea
rly (OR=
0
.
03
7 (95
%
C
I
=0.013
-
0
.
1
05)). (Tab
le 3)
Wo
m
e
n
who
were adv
i
sed
du
ri
n
g
ANC b
y
h
ealth
work
ers to
d
e
liv
er in a
h
ealth
facility
h
a
d a h
i
g
h
e
r
p
r
op
ortio
n d
e
li
v
e
ri
n
g
in
h
ealth
institu
tio
n
wi
th
a sk
illed
atten
d
a
n
t
co
m
p
ared
to tho
s
e
wh
o
were no
t.( Tab
l
e 3)
Propo
rtion
of wo
m
e
n
who d
e
liv
ered
in
h
ealth
in
s
titu
tio
n
with
sk
illed
care at
d
e
liv
ery in
creased with
kn
o
w
l
e
d
g
e o
f
bi
rt
h
rel
a
t
e
d c
o
m
p
li
cat
i
ons fr
o
m
1.4% am
on
g
wom
e
n w
ho
d
i
d n
o
t
m
e
nt
i
on any
t
o
8
.
7
%
a
m
ong
t
hose
w
h
o
m
e
nt
i
one
d
bi
rt
h r
e
l
a
t
e
d com
p
l
i
cat
i
ons
(p
<.
00
1)
.
Wom
e
n w
h
o
re
po
rt
ed
t
h
at
t
h
ey
ha
d
pr
evi
o
us
h
i
sto
r
y
o
f
ab
ortio
n
also
h
a
v
e
an
in
creased
ch
an
ce t
o
u
s
e
health
facilities
for d
e
liv
ery com
p
ared
to
th
ose who
had
n
o
p
r
evi
o
us hi
st
ory
o
f
abo
r
t
i
o
n (
O
R
8.
85
(9
5%C
I
(2
.5
8-
3
0
.
3
6
)
)
.
The fi
ndi
ng
o
f
t
h
i
s
st
u
d
y
sho
w
e
d
h
u
s
b
a
nd
’s
d
eci
sio
n
m
a
k
i
ng
po
wer is less l
i
k
e
ly asso
ciated
with
u
tilizatio
n
o
f
h
ealth
facility fo
r
d
e
l
i
v
e
r
y
co
m
p
ar
ed
t
o
decisio
n
m
a
k
i
n
g
po
w
e
r
o
f
bo
th
(
9
5
%
C
I
=0.075
- 0.544
)
.
(
T
able 3
)
All va
riables
whic
h s
h
owe
d
a sign
ificant association
wit
h
place
of
del
i
very care
in t
h
e
biva
riate
an
alysis were
p
u
t
in
a m
u
lt
ip
le lo
g
i
stic reg
r
essio
n
m
o
d
e
l by sp
littin
g
th
e v
a
riab
les in
to
two
group
s b
a
sed
on
th
e
presen
ce or
ab
sen
c
e o
f
ANC v
i
sit
to
assess ind
i
v
i
du
al
v
a
riab
le effect
s on
h
ealth
i
n
stitu
tio
n
d
e
liv
ery care
d
u
ring
b
i
rth (Tab
le
3
)
.Ho
w
ev
er, in
t
h
e m
u
ltiv
ariate an
al
ysis fiv
e
factors k
e
p
t
th
eir si
gn
ifican
t asso
ci
atio
n
s
with
th
e use
o
f
d
e
liv
ery serv
i
ce fro
m
h
ealth
facility.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJPHS Vol. 3, No. 4, D
ecem
ber 2014
:
224 – 230
22
8
Eve
n
aft
e
r c
o
n
t
rol
l
i
ng
fo
r c
o
nf
o
u
n
d
i
n
g fact
ors
,
w
o
m
e
n’s e
ducat
i
o
n l
e
vel
(
AOR
=
4
.
4
1
(
9
5
%
C
I
=1
.3
6-
1
4
.33)), timin
g o
f
ANC first v
i
sit (AOR
=
.
0
29 (
9
5% C
I
=.
0
0
4
-
.2
0
5
)
)
, w
o
m
e
n’s ad
vi
ce t
o
del
i
v
e
r
i
n
a heal
t
h
facility d
u
r
ing ANC (AOR
= 3
1
.
15
(95
%
CI=2
.0
2-
4
7
9
.
5
2
)),women
’s
kn
owled
g
e
o
f
b
i
rth
related
com
p
l
i
cat
i
ons(
AOR
=
12
.3
6 (
9
5
%
C
I
=2
.6
7-
57
.1
6
)) an
d
de
ci
si
on m
a
ki
ng po
we
r (A
OR
=.
21
9 (
9
5% C
I
=
.
0
5
8
-
.82
4
)) showed
sig
n
i
fican
t
asso
ciatio
n
with use
of
h
ealth
i
n
stitu
tio
n
at
d
e
livery. (Tab
le
3
)
Th
e
d
e
p
e
nd
en
t v
a
riab
le
wh
ich
h
a
s
b
e
en
u
s
ed
in th
e b
i
v
a
riate an
alysis is al
so
i
n
clud
ed in
th
e m
u
ltip
le
lo
g
i
stic regressio
n
analysis. Th
is v
a
riab
le is classifi
ed as di
chot
om
ous res
p
o
n
se
vari
a
b
l
e
whi
c
h i
s
assi
gne
d
t
h
e val
u
e
s
0
and
1. R
e
gar
d
i
ng t
h
e i
nde
p
e
nde
nt
va
ri
abl
e
s, o
n
l
y
t
hose
vari
a
b
l
e
s w
h
i
c
h sh
o
w
si
g
n
i
f
i
cant
relatio
n
s
h
i
p
s
with
in
stitu
tio
n
a
l d
e
liv
ery serv
ice u
tilizatio
n
are in
clud
ed
in
th
e regression
an
alysis. In
o
r
d
e
r to
determ
ine the
association
bet
w
een eac
h independe
n
t va
ria
b
le and
place of delivery two m
u
ltiple logistic
m
odel
s
were
u
s
ed.
The
m
a
i
n
con
s
i
d
erat
i
o
n
here i
s
t
h
e l
a
r
g
e n
u
m
b
er o
f
m
i
ssi
ng
res
p
o
n
se
s. T
hose
res
p
o
nde
nt
s
wh
o d
o
not
ha
ve ANC
vi
si
t
a
b
o
u
t
33
3 wer
e
not
a
s
ke
d fo
r
t
h
e
se
rvi
ces
p
r
o
v
i
d
e
d
du
ri
n
g
A
N
C
vi
si
t
a
n
d
t
h
ey
are
classified
as syste
m
missin
g
.
Th
erefo
r
e an
alysis was
mad
e
b
y
u
s
i
n
g
two
m
u
ltiv
ariate
m
o
d
e
ls
o
n
e
b
y
i
n
cl
udi
ng
va
ri
abl
e
s
of
A
N
C
(N=
2
13
) a
n
d
an
ot
he
r
by
e
x
cl
u
d
i
n
g t
h
em
(N=
5
46
).
T
h
eref
ore
w
o
m
e
n’s
age
,
m
a
t
e
rnal
educa
t
i
on, hi
st
o
r
y
of
abort
i
o
n, t
h
e l
a
st
preg
na
ncy
bei
n
g pl
an
ne
d,
t
i
m
i
ng of A
N
C
fi
rst
vi
si
t
,
advi
ce t
o
d
e
liv
er i
n
h
ealth
in
stitu
tio
n du
ri
n
g
ANC,
kn
owledg
e
o
f
birth
related
com
p
l
i
catio
n
s
and
d
ecisi
o
n
m
a
k
e
r
on
place
of delive
r
y ente
red in to
one m
odel a
n
d all va
riab
le
s
exce
pt tim
i
n
g
of ANC firs
t visit and advice to
d
e
liv
er in
h
ealth
institu
tio
n
during
ANC i
n
to ano
t
h
e
r m
o
d
e
l (Tab
le 3).
Tabl
e 3. Soci
o dem
ogra
phi
c
a
n
d
R
e
p
r
o
d
u
ct
i
v
e heal
t
h
determinants ass
o
ciated with deli
very services
u
tilizatio
n
b
y
wo
m
e
n
who
g
a
v
e
b
i
rth in
1
year
p
e
riod
i
n
B
o
rich
awored
a, Eth
i
o
p
i
a, 201
3
/
14
Variable
Place of
delivery
COR(95% CI)
AOR (95% CI)
Ho
m
e
delivery
institution birth
No
(%)
No
(%)
Wo
m
e
n
’
s
ag
e
15-
19
2(
40.
0%)
3(
60.
0%)
1.
00
1.
00
20-
24
107(
86.
3%)
17(
13.
7%)
0.
106 (
.
016-
.
681)
∗
0.
005(
.
000-
.
119)
25-
29
199(
97.
1%)
6(
2.
9%)
0.
020(
.
003-
.
143)
∗
0.
002 (
.
000-
.
040)
30-
34
143(
99.
3%)
1(
0.
7%)
0.
005(
.
000-
.
067)
∗
0.
000 (
.
000-
.
017)
35-
39
64(
100.
0%)
0
40-
44
4(
100.
0%)
0
M
a
ter
n
al E
ducation
Illiterat
e
and only
able to read
and wr
ite
384(
97.
7%)
9(
2.
3%)
1.
00
1.
00
Grade 1-6
104(
94.
5%)
6(
5.
5%)
2.
46(
0.
857-
7.
0
73)
1.
02(
0.
26-
4.
00)
Grade 7-10
31(
72.
1%)
12(
27.
9%)
16.
52(
6.
46-
4
2
.
22)
∗∗
4.
41
(
1
.
36-
14.
33)
∗
T
i
m
i
ng of ANC first visit
1-
3 m
onth/s
8(
33.
3%)
16(
66.
7%)
1.
00
1.
00
4-
6 m
onths
149(
93.
1%)
11(
6.
9%)
0.
037(
0.
01
3-
0.
105
)
∗
∗
.
029 (
0
.
004-
0.
20
5)
∗∗
7-
9 m
onths
29(
100.
0%)
0
Advice to deliver
in health
institution during ANC
NO
171(
90.
5%)
18(
9.
5%)
1.
00
1.
00
Yes
7(
50.
0%)
7(
50.
0%)
9.
50(
2.
99-
30.
15)
∗∗
31.
15 (
2
.
02-
479.
5
2
)
∗
I
don't r
e
m
e
m
b
er
8(
80.
0%)
2(
20.
0%)
2.
38(
0.
47-
12.
0
5
)
1.
17(
0.
056-
2
4
.
62)
Histor
y
of abor
tion
No
509(
95.
7%)
23(
4.
3%)
1.
00
Yes
10(
71.
4%)
4(
28.
6%)
8.
85(
2.
58-
30.
3
6
)
∗∗
3.
70(
0.
599-
22.
8
9
)
T
h
e last pr
egnancy being
planned
No
226(
99.
1%)
2(
.
9
%)
1.
00
1.
00
Yes
293(
92.
1%)
25(
7.
9%)
9.
64(
2.
26-
41.
13)
∗
4.
29 (
0
.
89-
20.
63)
Knowledge of bir
t
h r
e
lated
co
m
p
lic
ations
No
278(
98.
6%)
4(
1.
4%)
1.
00
1.
00
Yes
241(
91.
3%)
23(
8.
7%)
6.
63(
2.
26-
19.
45)
∗∗
12.
36
(
2
.
67-
57.
1
6
)
∗
Decision m
a
ker
Both of us
222(
91.
0%)
22(
9.
0%)
1.
00
1.
00
M
y
husband
249(
98.
0%)
5(
2.
0%)
0.
203(
0.
07
5-
0.
544
)
∗
0.
219
(
0
.
058-
0.
8
2
4
)
∗
Myself
42(
100.
0%)
0
Husband's fa
m
ily
6(
100.
0%)
0
CI = Confid
ence In
terv
al, OR = Od
ds ratio;
∗
Sign
ifican
t at p
<0
.0
5,
∗∗
si
gni
fi
cant
at
p <
0
.
0
01
, {
A
d
j
ust
e
d
for all th
e i
n
d
e
p
e
nd
en
t v
a
riables in
d
i
cated in th
e tab
l
e}
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Fa
cto
r
s Asso
ci
a
t
ed
with In
stitu
tio
na
l
Delivery in
Bo
richa
District o
f
S
i
da
ma
Zon
e
.... (Ta
f
ese Ta
d
e
le)
22
9
4.
DIS
C
USSI
ON
Fin
d
i
n
g
s
o
f
t
h
is stud
y showed
th
at
on
ly few o
f
th
e respo
nden
t
s
h
a
d d
e
liv
ered in
h
ealth
i
n
stitu
tio
n
b
y
a sk
illed
p
r
ovid
e
r. Th
is is lo
wer co
m
p
ared
to
th
e re
po
rt o
f
Eth
i
op
ian Dem
o
g
r
aph
i
c an
d
Health
Su
rv
ey
(ED
H
S
)
2
0
1
1
result fo
r SN
N
P
R (6.
2
%
)
(5
) and FM
OH re
po
rt of 2
0
10
w
h
ich in
dicate less than 1
6
.
8
% [1
0]
.
This could
be
because the
DHS and FM
OH
report inc
l
udes t
h
e urba
n areas
where
consi
d
era
b
ly a large
num
ber
of
del
i
veri
es at
t
e
n
d
e
d
by
heal
t
h
p
r
ofessi
o
n
al
s. Th
is estim
a
t
e co
m
p
ares well
with
Am
h
a
ra
reg
i
o
n
(4.7
%)
o
b
s
erved
in
t
h
e last
1
0
k
ilo
m
e
ter base lin
e hou
se
h
o
l
d
su
rv
ey 200
9
bu
t lower co
m
p
ared
to the rates
obt
ai
ne
d f
r
om
t
h
e st
udy
re
gi
o
n
(9
%) i
n
t
h
e
sam
e
survey
(
6
)
.
Ou
r fi
n
d
i
n
g i
s
al
so l
e
ss than t
h
e fi
n
d
i
n
gs fr
om
st
udy
c
o
n
d
u
ct
ed i
n
di
f
f
ere
n
t
p
a
rt
of
Et
hi
o
p
i
a
16
%,
1
9
.6
%, 12
.3
%, 12
.1
%
an
d
16
% on programm
atic
correlate
of m
a
t
e
rnal
he
al
t
h
care see
k
i
n
g
be
ha
vi
o
r
s i
n
Et
hi
o
p
i
a
, ut
i
l
i
zat
i
on o
f
a
n
t
e
nat
a
l
care se
r
v
i
ces am
ong t
e
e
n
age
r
s
i
n
Et
hi
o
p
i
a
, M
uni
sa w
o
reda
So
ut
h East
of
Et
hi
o
p
i
a
,
N
o
rt
h
W
e
st
of Et
hi
opi
a an
d Kem
b
at
t
a
-Tem
baro
zone o
f
So
ut
h Et
hi
o
p
i
a
respe
c
t
i
v
el
y
[7]
,
[8]
,
[1
1]
-[
1
3
]
.
A
n
d i
t
i
s
al
so fa
r l
e
ss t
h
an
fi
n
d
i
n
gs
f
r
om
Uga
nda
(
4
5.
4%)
,
Ni
ge
ri
a (4
3.
5
%
), Ke
ny
a (4
2.
6 %), I
n
di
a (4
4%
) and Pa
ki
st
an (
41%
) [
14]
-
[
18]
. Thi
s
coul
d
be due
t
o
t
h
e
diffe
re
nce in maternal c
h
aract
eristics and the
setup.
The M
a
jo
ri
t
y
(97
.
3
%
)
of
w
o
m
e
n w
ho
del
i
v
ered t
h
ei
r i
n
fa
n
t
s at
hom
e com
m
onl
y
m
e
nt
i
oned l
a
b
o
u
r i
s
sho
r
t
a
n
d
ease
f
o
r
t
h
em
. Thi
s
fi
n
d
i
n
g
was
hi
g
h
er
t
h
a
n
c
r
oss
sect
i
onal
s
t
udy
do
ne
i
n
No
rt
h
W
e
st
Et
hi
o
p
i
a
3
3
.4% said
labo
r
was sh
ort/ u
r
g
e
n
t
an
d
21
.6
% said
t
h
ey d
i
d
n
o
t
h
a
v
e
an
y p
r
ob
lem
to
g
o
t
o
h
ealth
facilities
[8]
.
Thi
s
st
u
d
y
re
v
eal
ed 3
9
%
of
t
h
e res
p
on
de
nt
s ha
d
attended ANC at least
once in t
h
eir
gestational
peri
od
. T
h
i
s
fi
ndi
ng
was i
n
l
i
n
e
wi
t
h
t
h
e st
u
d
y
do
ne i
n
M
u
ni
saDi
st
ri
ct
of
So
ut
h
East
Et
h
i
opi
a
w
h
i
c
h
re
veal
ed
34
.7
% of m
o
t
h
ers ha
d at
l
east
one
ANC
vi
si
t
duri
ng t
h
ei
r l
a
st
pre
gna
ncy
one y
ear
pri
o
r
t
o
t
h
e st
u
d
y
pe
ri
o
d
.
Bu
t it is no
t con
s
isten
t
with
fin
d
i
n
g
fro
m
Kem
b
at
ta-Tem
baro
o
f
S
N
NPR
a
n
d
Se
kel
a
di
st
r
i
ct
of
N
o
rt
h
West
o
f
Eth
i
op
ia wh
ich
was 71
% and
66
.8
% resp
ectiv
ely (7
, 8
)
. And
it was also
no
t si
m
ilar
with
th
e stud
y d
o
n
e
in
Lu
bum
bashi
c
i
t
y
of
Dem
o
crat
i
c
R
e
pu
bl
i
c
of
C
o
n
g
o
–
9
2
.
6
% a
n
d
Ke
n
y
a
dem
ogra
p
h
i
c an
d
heal
t
h
sur
v
e
y
resul
t
w
h
i
c
h i
s
92
.6%
[
19]
,
[
1
6
]
.
The i
n
co
ns
i
s
t
e
ncy
of
t
h
e
fi
n
d
i
n
gs co
ul
d
be d
u
e
to m
a
ternal c
h
aracters a
nd
resi
de
nt
di
ffe
re
nt
.
In t
h
i
s
st
u
d
y
a num
ber of i
m
po
rt
ant
soci
o d
e
m
ogra
p
hi
c an
d rep
r
od
uct
i
v
e
heal
t
h
fact
ors
were f
o
un
d
to
h
a
ve a sign
ifican
t influ
e
n
ce on
u
tilizatio
n
of in
stitu
t
i
o
n
a
l d
e
liv
ery serv
ices at ch
ild
b
i
rt
h
.
It in
clud
e
wo
m
e
n
’
s edu
c
atio
n
,
wo
m
e
n
’
s adv
i
ce to d
e
l
i
v
e
r i
n
h
ealth
i
n
stitu
tio
n du
ri
n
g
ANC, ti
m
i
n
g
o
f
ANC
first
v
i
sit,
wom
e
n’s
knowledge of
birt
h related com
p
lications
a
n
d decision
m
a
king powe
r on place
of
delivery.
The
st
ro
nge
st
ass
o
c
i
at
i
on wa
s f
o
u
n
d
i
n
t
i
m
i
ng o
f
A
N
C
fi
r
s
t
vi
si
t, which
was
also true i
n
the
bivariate analysi
s
.
In
th
is stud
y li
terate
m
o
th
ers were m
o
re lik
ely
u
s
e h
ealth
facility
d
u
r
ing
d
e
liv
ery th
an
illiterate an
d
onl
y
abl
e
t
o
re
ad an
d wri
t
e
.
St
udi
es d
o
n
e i
n
M
uni
sa
Di
st
ri
ct
of So
ut
h Ea
st
Et
hi
opi
a, Se
kel
a
di
st
ri
ct
of
Nort
h
West
Et
hi
opi
a
an
d I
n
di
a sh
ows
si
m
i
l
a
r fi
ndi
ng
w
h
i
c
h i
s
m
a
t
e
rnal
ed
ucat
i
onal
l
e
vel
ha
ve st
r
o
n
g
posi
t
i
v
e
association with
place of delivery
[8
],[9],[20]. In study don
e in Munisa
wore
da,
husba
nd’s education s
h
ows a
stron
g
an
d
si
gn
ifican
t asso
ciatio
n
with
th
e
u
tilizatio
n
o
f
i
n
stitu
tio
n
a
l d
e
l
i
v
e
ry serv
ices [13
]
b
u
t
th
is fi
n
d
i
ng
d
i
dn
’t sh
owed th
e asso
ciatio
n
with
h
ealth
in
stitu
tion
deliv
ery. It could
b
e
d
u
e
t
o
th
e v
a
st m
a
j
o
rity o
f
respon
d
e
n
t
s were b
e
ing
illiterate.
The fi
n
d
i
n
g o
f
our st
u
d
y
sh
o
w
ed t
w
el
ve (2
7.
9%)
wom
e
n wi
t
h
ed
ucat
i
o
n
a
l
at
t
a
i
n
m
e
nt
of gra
d
e 7
-
1
0
u
tilized
h
ealth
facility d
u
r
ing
d
e
liv
ery
o
f
th
eir in
d
e
x
ch
il
d
.
Th
e resu
lts of
th
is stu
d
y
are
si
m
ilar co
m
p
ared
to
t
h
e re
po
rt
of
K
e
ny
a Dem
ogra
phi
c a
nd
Heal
t
h
S
u
r
v
ey
(
K
D
H
S)
2
0
0
8
/
0
9
r
e
sul
t
(2
7%
) (
1
6)
.Thi
s i
s
fa
r l
e
ss t
h
an
fi
n
d
i
n
gs
fr
om
Ni
ge
ri
a’s
(7
5.
8
%
)
[1
7]
. t
h
i
s
c
oul
d
be
di
ffe
re
nces i
n
t
h
e
l
o
c
a
l
cont
e
x
t
s
.
Wo
m
e
n
who
were kno
wledg
eab
le of
b
i
rth related co
m
p
licatio
n
s
were m
o
re
lik
ely
to
u
tilize
h
ealth
facilities fo
r d
e
liv
ery co
m
p
ared
to
th
ose with n
o
kno
wl
ed
g
e
(AOR=12
.
3
6
(9
5% CI=2.67
-
5
7
.16)). Th
e fi
n
d
i
ng
of
ou
r st
u
d
y
s
h
o
w
e
d
8
.
7%
wom
e
n w
ho
h
a
ve k
n
o
wl
e
dge
of
bi
rt
h
rel
a
t
e
d com
p
l
i
cat
i
o
n
s
gave
bi
rt
h i
n
heal
t
h
in
stitu
tio
n
.
Th
e find
ing
o
f
th
is stu
d
y
is con
s
isten
t
with
Tan
z
an
ia’s
(7
.4
%)
[21
]
and
less than
Ken
y
a’s (18.5
%
)
[22].
It is expe
cted that a
bett
er
inform
ed individual is
better
placed
t
o
m
a
ke reasona
b
le decisions.
Th
e st
reng
th of th
is st
ud
y inclu
d
e
s: it is a co
mm
u
n
ity b
a
sed
;
cen
s
us
was co
ndu
cted b
e
fore
d
a
ta
co
llectio
n
to
id
en
tify wo
m
e
n
wh
o
g
a
v
e
birth
in
th
e last o
n
e
year and also
larg
e sam
p
le
size was u
s
ed
.
Li
m
ita
tio
n
s
o
f
th
e stud
y are:
th
ere cou
l
d b
e
so
cial
d
e
si
rabilit
y b
i
as; to
red
u
c
e th
is
we used
h
ealth ex
ten
s
ion
wo
rk
ers fr
om
ot
he
r kebel
e
s.
5.
CO
NCL
USI
O
N
Th
e stud
y id
en
tified
v
e
ry low u
tilizatio
n
of d
e
liv
ery
services fro
m
h
eal
th
in
stitu
tio
n
s
in
th
e area.
Wo
m
e
n
’
s educatio
n
,
timin
g o
f
ANC first
v
i
sit, ad
v
i
ce d
u
r
i
n
g
ANC
v
i
sit to
d
e
liv
er in
h
ealth
facility
,
k
nowledg
e of
b
i
rth
related
co
m
p
licatio
n
s
an
d
co
mm
u
n
a
l
d
ecision
m
a
k
i
n
g
ro
le affected in
stitu
tio
n
a
l deliv
ery
serv
ice
u
tilizatio
n
i
n
t
h
e area.Raisin
g
awaren
ess
o
n
in
st
itu
tio
n
a
l
d
e
livery to
m
a
x
i
m
i
ze d
e
liv
ery serv
ice
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJPHS Vol. 3, No. 4, D
ecem
ber 2014
:
224 – 230
23
0
u
tilizatio
n
an
d stren
g
t
h
e
n
i
n
g
p
r
ov
ision
of ed
u
cation
and co
un
seling
to d
e
liv
er in
h
e
alth
facility
d
u
r
i
ng
ant
e
nat
a
l
care
vi
si
t
s
at
i
ndi
vi
dual
a
n
d c
o
m
m
uni
t
y
l
e
vel
sho
u
l
d
be
gi
ven
d
u
e em
phasi
s.
ACKNOWLE
DGE
M
ENTS:
The a
u
thors a
r
e ve
ry
grateful
to
B
o
ric
h
a dis
t
rict
fo
r its adm
i
nistra
tive and technical ass
i
stance. The
scho
o
l
of pu
blic h
ealth
an
d en
v
i
ron
m
en
ta
l scien
ce,
college of m
e
dicine and health science, Ha
wass
a
Uni
v
ersi
t
y
des
e
rves
ac
kn
owl
e
dgem
e
nt
f
o
r
gi
vi
ng
a c
h
a
n
ce a
n
d si
da
m
a
zone
heal
t
h
de
pa
rt
m
e
nts al
s
o
t
h
esau
ru
s f
o
r fi
nanci
a
l
s
u
pp
ort
.
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