title: Determinants of institutional childbirth service utilisation among women of childbearing age in urban and rural areas of Tsegedie district, Ethiopia.
abstract: BACKGROUND
  despite receiving greater attention, optimal maternal health remains a challenge in developing countries such as Ethiopia. Evidence from various studies shows that skilled attendance during childbirth is among the key strategies to reduce maternal mortality. However, in Ethiopia, the use of institutional childbirth services is very low. In Ethiopia, studies dealing with factors affecting women׳s use of institutional childbirth services are scarce and generally focus on urban settings. As such, this study aimed to explore the determinants of institutional childbirth service utilisation among urban and rural women who gave birth in the previous two years in Tsegedie district, Ethiopia.
  
  
  METHODS
  a community-based cross-sectional study was performed from 20 November 2012 to 30 June 2013 on 485 mothers. The participants were selected systematically using a multistage sampling technique. A pre-tested structured questionnaire, administered by an interviewer, was used to collect quantitative data. Focus group discussions and in-depth interviews were used to triangulate the evidence from the quantitative study. Bivariate and multivariate data analysis was performed using Statistical Package for the Social Sciences Version 17.0.
  
  
  RESULTS
  this study found that 31.5% of the respondents used institutional childbirth services. The main reason for home birth was close attention from family (47%). Women׳s educational status [adjusted odds ratio (AOR) 5.3, 95% confidence interval (CI) 1.59-17.87], time taken to reach the nearest health facility (AOR 3.3, 95% CI 1.15-9.52), ultimate decision maker regarding the place of childbirth (AOR 3.7, 95% CI 1.08-12.63) and receipt of maternal and child health care information (AOR 9.4, 95% CI 2.4-36.38) were significantly associated with the use of institutional childbirth services.
  
  
  CONCLUSIONS
  the proportion of births attended in health facilities was low in the study district. Women׳s educational status, distance to the nearest health facility, women׳s decision-making power and receipt of maternal and child health care information were important predictors of institutional childbirth service utilisation. This implies that women still lack physical and effective access to maternal health care services. Thus, improving community awareness about skilled providers and institutional childbirth, targeting women who prefer to give birth at home, is encouraged. Safe motherhood education using communication networks in rural and urban communities is crucial. Furthermore, it is recommended that essential obstetric care facilities (health centres) should be established within a reasonable distance of homes, women should be empowered and community midwives should be deployed.
authors.affiliation: Department of Nursing and Midwifery, Arba Minch University, Arba Minch, Ethiopia. Electronic address: destahailu30@yahoo.com.
authors.forename: Desta
authors.initials: D
authors.lastname: Hailu
authors.affiliation: Department of Nursing, Mekelle University, Mekelle, Ethiopia.
authors.forename: Hailemariam
authors.initials: H
authors.lastname: Berhe
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005002:Ethiopia; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D000068101:Maternal-Child Health Services / Q000706:statistics & numerical data*; D036801:Parturition; D011247:Pregnancy; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data*
keywords: Cross-sectional study; Determinant factors; Institutional childbirth; Tsegedie district