title: Why do women deliver at home? Multilevel modeling of Ethiopian National Demographic and Health Survey data.
abstract: BACKGROUND
  Despite of the existing intensive efforts to improve maternal health in Ethiopia, the proportion of birth delivered at home remains high and is still the top priority among the national health threats.
  
  
  OBJECTIVE
  The study aimed to examine effects of individual women and community-level factors of women's decision on place of delivery in Ethiopia.
  
  
  METHODS
  Data were obtained from the nationally representative 2011 Ethiopian Demographic and Health Survey (EDHS) which used a two-stage cluster sampling design with rural-urban and regions as strata. The EDHS collected data from a big sample size but our study focused on a sample of 7,908 women whose most recent birth was within five years preceding 2011 and 576 communities in which the women were living in. The data were analyzed using a two-level mixed-effects logistic regression to determine fixed-effects of individual- and community-level factors and random-intercept of between-cluster characteristics.
  
  
  RESULTS
  In the current study, 6980 out of 7908 deliveries (88.3%) took place at home. Lower educational levels (OR=2.74, 95%CI:1.84,4.70; p<0.0001), making no or only a limited number of ANC visits (OR=3.72,95%CI:2.85, 4.83; p<0.0001), non-exposure to media (OR=1.51, 95%CI 1.13, 2.01; p=0.004), higher parity (OR=2.68, 95%CI:1.96,3.68; p<0.0001), and perceived distance problem to reach health facilities (OR=1.29, 95%CI:1.03,1.62; p=0.022) were positively associated with home delivery. About 75% of the total variance in the odds of giving birth at home was accounted for the between-community differences of characteristics (ICC=0.75, p<0.0001). With regard to community-level characteristics, rural communities (OR=4.67, 95%CI:3.06,7.11; p<0.0001), pastoralist communities (OR=4.53, 95%CI:2.81,7.28; p<0.0001), communities with higher poverty levels (OR=1.49 95%CI:1.08,2.22; p=0.048), with lower levels of ANC utilization (OR=2.01, 95%CI:1.42,2.85; p<0.0001) and problem of distance to a health facility (OR=1.29, 95%CI:1.03,1.62; p=0.004) had a positive influence on women to give birth at home.
  
  
  CONCLUSIONS
  Not only individual characteristics of women, but also community-level factors determine women's decision to deliver at home.
authors: Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
authors: Henock
authors: H
authors: Yebyo
authors: Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
authors: Mussie
authors: M
authors: Alemayehu
authors: Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
authors: Alemayehu
authors: A
authors: Kahsay
mesh_terms: D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric / Q000191:economics / Q000523:psychology* / Q000706:statistics & numerical data; D003710:Demography; D005002:Ethiopia; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006306:Health Surveys; D006700:Home Childbirth / Q000191:economics / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D010298:Parity; D011247:Pregnancy; D012424:Rural Population; D012959:Socioeconomic Factors; D014505:Urban Population