title: Factors associated with Institutional delivery service utilization among mothers in Bahir Dar City administration, Amhara region: a community based cross sectional study.
abstract: BACKGROUND
  High maternal mortality is a continued challenge for the achievement of the fifth millennium development goal in Sub-Saharan African countries including Ethiopia. Although institutional delivery service utilization ensures safe birth and a key to reduce maternal mortality, interventions at the community and/or institutions were unsatisfactorily reduced maternal mortality. Institutional delivery service utilization is affected by the interaction of personal, socio-cultural, behavioral and institutional factors. Therefore this study was designed to assess factors associated with institutional delivery service use among mothers in Bahir Dar city administration.
  
  
  METHODS
  A community based cross sectional study was conducted in Bahir Dar City administration Northwest of Addis Ababa, Ethiopia. Four hundred eighty four mothers were included in the study. Data were collected by trained female data collectors. Descriptive statistics, binary and multivariable logistic regression analyses were computed. Statistical significance was considered at p < 0.05 and the strength of statistical association was assessed by odds ratios (OR) with 95% confidence intervals.
  
  
  RESULTS
  In this study, 78.8% of women gave birth to their current child at health institution. The multivariable logistic regression showed that, attending primary education (AOR = 4.7[95% CI:1.3-16.7], secondary education (AOR = 3.5[95% CI:1.1-10.7]), age at first marriage; first time marriage at 15-19 years (AOR = 5.4[95% CI:2.0-15.0]) and first time marriage at 20-24 years (AOR = 5.0[95% CI:1.5-16.8] and gestational age at first ANC visit (first trimester) (AOR = 5.3[1.3-22.2]) and second trimester (AOR = 2.8[95% CI:0.7-11.]) were independent factors affecting institutional delivery service utilization.
  
  
  CONCLUSIONS
  In this study, institutional delivery service utilization is optimal, urban mothers were more likely to practice institutional delivery. This study indicated that age at first marriage, educational status of the women and gestational age at first ANC visit are independent predictors of delivery service utilization. Hence, intensifying education for women and behavior change communication (BCC) interventions to increase early initiation and up-take of ANC service use in the first trimester and delaying marriage are recommended to promote institutional delivery service utilization.
authors.forename: Gedefaw
authors.initials: G
authors.lastname: Abeje
authors.forename: Muluken
authors.initials: M
authors.lastname: Azage
authors.affiliation: Public Health Department, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia. tesfayesetegn@yahoo.com.
authors.forename: Tesfaye
authors.initials: T
authors.lastname: Setegn
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric; D004522:Educational Status; D005002:Ethiopia; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008428:Maternal Mortality; D009035:Mothers; D015999:Multivariate Analysis; D016017:Odds Ratio; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors