Prevalence of Home Delivery and Factors associated among women who gave Birth in the last two years in Tulla Sub City, Hawassa, Southern Ethiopia, 2014
Alemneh Kabeta*, Gezahegn Bekele, Adugnaw Adane
School of Nursing and Midwifery, Hawassa University, Hawassa, Ethiopia
*Corresponding Author Email: alemneh33@gmail.com
ABSTRACT:
Introduction: Maternal morbidity and mortality is concern throughout the world. Pregnancy and birth related complications are among the leading causes of maternal deaths. Even though increasing number of births given in health institution with the assistance of health care provider is considered basic to improve the bad outcomes the situation is worse in Ethiopia. As intervening for improvement needs sound understanding this research work aimed to assess prevalence of home delivery and associated factors among births given in the last two years in Tulla sub-city, Hawassa, Southern Ethiopia, 2014.
Methodology: A community based cross-sectional study design was employed. By using simple random sampling technique 83 mothers were selected and interviewed with semi-structured questionnaire. Data was analyzed using descriptive statistics and chi-square test.
Result: Prevalence of home delivery was found being 32 (38.5%). Wish to give birth with the presence of relatives, short duration of labor and non-kind care of health workers were commonly reported reasons for home delivery. Educational status of the women (X2=16.71, df=3 & p-value <0.001), household monthly income(X2=5.11, df=2 & p-value <0.05) and receiving ANC follow up (X2=16.25,df=2, p-value <0.01) and distance of health institution from home (X2=24.90 , df=1 , p-value <0.001) were significantly associated with place of delivery.
Conclusion: Prevalence of home delivery was less than regional figure and in country research findings. Wish to give birth with the presence of relative, short duration of labor and non-kind behavior of health care providers were common reasons of home delivery. Women educational status, household monthly income, ANC follow up and distance are associated with place of delivery. Even though home delivery prevalence is low in the study area it is considerable as the country is with motto of no maternal death. Due emphasis better be given to improve women educational status, household income, attendance of ANC and distance. Further research could also be conducted with large sample size and statistics showing strength and direction of association.
KEY WORDS: Maternal death, Home delivery, Tulla, Ethiopia
INTRODUCTION:
In spite of the global and national efforts made to reduce maternal morbidity and mortality, it remains a major challenge to health care system worldwide [1]. World Health Organization (WHO) has reported slow progress of proportion of deliveries attended by skilled health care providers both worldwide (rose from 58 percent in 1990 to 68 percent in 2008) and in Africa (remained only at 50%) (2). Out of 515,000 yearly and 1600 daily maternal deaths throughout the world about half occurs in developing countries like India, Nigeria, Pakistan, Afghanistan, Ethiopia, and the Democratic Republic of Congo (3 & 4). The proportion of women who delivered with the assistance of skilled birth attendant is one of the indicators for being in truck of changing the situation. Almost in all countries, where health care providers attend more than 80% of deliveries, MMR is below 200 per 100,000 live births (5). However, birth without skilled attendant was high in south Asia (55%) and SSA (50%) the two regions with the greatest number of maternal deaths (6). Around 90% of births in Ethiopia are delivered at home that means 9 Women in every 10. In southern nation nationalities and peoples Region (SNNPR), prevalence of home delivery was a bit higher (93.5%) and the leading from all other regions of the country. In Ethiopia, the proportions of birth attended by non-skilled personal are higher than Sub-Saharan countries (7). So that this study aimed of assessing prevalence of home delivery and associated factors among births given last two years in Tulla sub-city, Hawassa, Southern Ethiopia, 2014.
METHODS AND MATERIALS:
Study Setting and Design:
This community based cross sectional study was conducted in Tulla Sub-city of Hawassa town, southern Ethiopia from May 26 To June 6, 2014.Tulla Sub-city: found about 13 KMs far from Hawassa (capital of the Southern National Nationalities Regional States) and 287KMs away from Addis Ababa (capital of the country). The total population in this town was estimated to be 5248 with about 1071 households.
Sample Size and Sampling Procedure:
Sample size was calculated by single population proportion formula with assumption of 95% confidence interval, 93.5% prevalence of regional home delivery and 5%margin of error. Considering the assumption sample size was determined to be 94. By the house to house census made total number of women who gave birth by the last two years were counted to be 368 and this obliged correction of the sample using finite correction formula. By the correction calculation done on the sample size it was down sized to 75. Adding 10% of the already corrected sample size final sample size was decided to be 83. Using the house to house numbering as a sampling frame sample was selected using simple random sampling technique.
Data Collection Analysis:
Interviewer administered semi-structured questionnaire was used to collect the data. Data collectors were graduating class BSc nursing students. The already collected data was checked for completeness, cleaned and tallied for statistical analysis. Descriptive statistics was generated from the tally. Chi-square was used to determine association between socio-demographic/ economic and obstetrics related variables and place of delivery.
ETHICAL ISSUE:
Letter of cooperation written from College of Medicine and Health Sciences, Hawassa University was submitted to the area administrative bodies. Rationale of the research work was explained and oral consent was secured from the study participants.
RESULT:
A total of 83 women who gave birth in the last two years were interviewed with a response rate of 100%. Among the total women interviewed, 59(72%) are between 20 and 34 years, 79(95.2%) were Sidama in ethnicity, 62(74.5%) were protestants in their religion, 79(95.2%) were married and 71(85.5%) were house wives. Concerning educational status 45(54.2%) are within 1-8 (primary education) grade range. About half of the women 40(48%) are residents of household with monthly income between 500 and 1500 ETB.
About half of the 43(51.2%) of the respondents were between 15 and 19 years of age at their first pregnancy and twenty eight (33%) were primi-gravida (women who gave birth for the first time). More than half study participants, 49(59%) reported ANC follow up to fourth visit where as 13(15.7%) were with no follow up. Out of women who had no ANC visit 6(46.15%) were due to lack of awareness and 5(38.8%) were busy to go to health institution.
Place Where Delivery was Given and Reasons:
Among the total number of respondents 32(38.5%) gave birth at home and 51(61%) gave birth at health institution. Reasons for health institutional delivery were being informed to deliver in health institution 36(70.3%), kind care of health workers and seeking better service 8(15%) and 4(7%) were being close to the health institution %); Wish to give birth in the presence of relatives, 12(37.5%), short duration of labor, Y(34.3%) were major reasons of home delivery. of 32 respondents who gave birth at home, 8(25%) faced complications during their delivery: four faced prolonged labor and 3 had retained placenta. From those who faced complications 5(62.5%) seek health care to manage the complication and 3(37%) were relieved spontaneously.
Table 1 Socio-demographic characteristics of respondents in Tulla town, June 2014
|
Variable |
Categories |
Frequency |
Percentage |
|
Age of women in years |
15-19 |
11 |
13.2% |
|
20-24 |
8 |
22% |
|
|
25-29 |
28 |
34% |
|
|
30-34 |
13 |
16% |
|
|
35-39 |
7 |
9.4% |
|
|
40-44 |
4 |
5% |
|
|
Marital status |
Married |
79 |
95.2% |
|
Widowed and divorced |
4 |
4.8% |
|
|
Religion |
Protestant |
62 |
74.7% |
|
Orthodox |
4 |
4.8% |
|
|
Muslim |
17 |
20.5% |
|
|
Ethnicity |
Sidama |
79 |
95.2% |
|
Oromo |
2 |
2.4% |
|
|
Amhara |
2 |
2.4% |
|
|
Educational status the women |
No formal education |
21 |
25.3% |
|
1-8 |
45 |
54.2% |
|
|
9-10 |
15 |
18% |
|
|
12+ |
2 |
2.4% |
|
|
Occupation |
House wife |
71 |
85.5% |
|
Merchant |
8 |
9.6% |
|
|
Government employee |
2 |
2.4% |
|
|
Private employee |
1 |
1.2% |
|
|
Student |
1 |
1.2% |
|
|
Income |
<500 ETB |
16 |
19.3% |
|
500-1500 ETB |
40 |
48.2% |
|
|
>1500 ETB |
27 |
32.5% |
ETB: Ethiopian Birr
Table.2: Obstetric characteristics of respondents in Tulla sub-city, Hawassa. Southern Ethiopia, 2014
|
Variable |
Categories |
Frequency |
Percentage |
|
Age of first pregnancy |
<15 |
8 |
9.6% |
|
15-19 |
43 |
51.8% |
|
|
20-24 |
30 |
36.1% |
|
|
>25 |
2 |
2.4% |
|
|
Parity |
1 |
28 |
33.7% |
|
2-4 |
35 |
42.1% |
|
|
>5 |
20 |
24.1% |
|
|
Alive birth |
1 |
22 |
26.5% |
|
2-4 |
3 |
46.9% |
|
|
>5 |
22 |
26.5% |
|
|
Previous experience of adverse birth outcome |
Yes |
8 |
9.6% |
|
No |
75 |
90.5% |
|
|
No of ANC Visits |
0 |
13 |
15.7% |
|
1 |
1 |
1.2% |
|
|
2 |
6 |
7.2% |
|
|
3 |
13 |
15.7% |
|
|
4 |
49 |
59% |
|
|
Place of ANC visit |
Hospital |
6 |
8.6% |
|
Health center |
63 |
90% |
|
|
Health post |
1 |
1.4% |
|
|
Average waiting time for ANC follow up in minutes |
<15 |
30 |
42.8% |
|
15-30 |
24 |
34.3% |
|
|
>30 |
16 |
22.8% |
|
|
Reason for not having ANC follow up |
No awareness |
6 |
46.1% |
|
Too busy to go to health institution |
5 |
38.3% |
|
|
Religious view |
1 |
7.7% |
|
|
Too far health institution |
1 |
7.7% |
Among the total number of respondents who had ever been served in the nearby health institution, 50(60%) were satisfied with the service given while the remaining 33(40%) were not. And from the total respondents, 45 (54.2%), 26(31.1%), and 12(4.5%) characterized behavior of health workers as good, fair and bad respectively. Forty six (90.1%) women travel less than 5 kilometers whereas 5(9.8%) travel >5 kilometers to reach to the nearest health institution. Reported time taken to reach to the health institution were 15minutes, 15-30 minutes, and >30 minutes for 35(42.2%), 25(30%) and 23(27.8%) women respectively. Among women who gave birth in health institution 25(49%) traveled by ambulance, 17 (33%) use other methods (Cart, Bajaj, Car…) and 9 (18%) travel on foot to reach to the nearby health institution.
Figure 2.Reasons for giving birth at home in Tulla town, southern Ethiopia, 2014
Women educational status of ( x2=16.71, df = 3, p-value <0.001), house hold monthly income (x2=5.11. df =2 , p-value <0.02 ), antenatal care follow up (X2=5.11, df=2 & p-value <0.05) and distance of health institution from home (( x2=24.9, df= 1 , p-value <0.001 ) significantly associated with place of delivery.
DISCUSSION:
In this study we have tried to assess the prevalence of home delivery and associated factors among women who gave birth in the last two years in Tulla Sub-city, southern Ethiopia. The study revealed that the prevalence of home delivery in the study area is 38.5% and it is lower than regional figure (93.5%) and research findings done in Munisa (87.2%), Tigray (95.9%), and North Gondar (86.5%) (7, 8, 9 and 10).
Table 3: Association of selected variables with place of delivery in Tulla Sub-city, Hawassa, Southern Ethiopia, 2014
|
Variable |
Category |
Place of Delivery |
df |
X2 |
P-value |
|
|
|
|
Home |
Health Institution |
|||
|
|
|
N (%) |
N (%) |
|
|
|
|
Age of women in Years
|
<20 Years |
5(15.6) |
7(13.7) |
2
|
0.46
|
>0.2
|
|
20-34 |
22(68.7) |
38(74.5) |
||||
|
35-49 |
5(15.6) |
6(11.8) |
||||
|
Mother's educational status
|
No formal education |
15(46.8) |
6(11.8) |
3
|
16.7
|
<0.001
|
|
1-8 grade |
15(46.8) |
30(58.8) |
||||
|
9-11grade |
2(6.4) |
13(25.5) |
||||
|
12+ |
|
2(3.9) |
||||
|
Occupation
|
Housewife |
28(87.5) |
41(80.4) |
3
|
0.45
|
>0.05
|
|
Merchant |
3(9.3) |
8(15.7) |
||||
|
Government employee |
1(3.1) |
1(1.9) |
||||
|
Private employee |
|
1(1.9) |
||||
|
Family monthly income
|
<500ETB |
7(21.8) |
5(9.8) |
2
|
5.11
|
<0.05
|
|
500-1500 ETB |
20(62.5) |
31(60.8) |
||||
|
>1500 |
5(15.6) |
15(29.4) |
||||
|
Number of births given
|
1 |
7(21.8) |
19(37.2) |
2
|
2.80
|
>0.5
|
|
2-4 |
18(56.2) |
25(49) |
||||
|
>5 |
7(21.8) |
7(13.7) |
||||
|
Previous experience of adverse birth outcome
|
Yes |
1()3.2 |
3(5.9) |
1 |
1.05 |
>0.05 |
|
No |
31(96.8) |
48(94.1) |
||||
|
Number of total ANC visit for last pregnancy
|
None |
11(34.3) |
4(7.8) |
2
|
16.25
|
<0.01
|
|
1-2 |
6(18.7) |
2(3.9) |
||||
|
3-4 |
1546.8) |
45(88.2) |
||||
|
Estimated distance of home from health institution |
<5KMs |
13(40.6) |
46(90.1) |
1 |
24.9 |
<0.001 |
|
>5KMs |
19(59.3) |
5(9.8) |
||||
The less prevalence of home delivery might be due to difference in study setting, small sample size, health information dissemination by health extension workers (HEWs) in the area and currently applied cost free delivery service in health facilities. Several reasons for giving birth at home were identified including wish to give birth in the presence of relatives and nearby friends (37.5%), short duration of labor (34.3%), trust on TBAs (15%), and bad behavior of health workers (12.5%). This finding is similar with studies conducted in Arsi zone, woldia, Gondar town, Pakistan, and Indonesia (10, 11, 12, 13 & 14). Consistent with findings of different studies (15, 16, 17, 18 & 19) women educational status (x2=16.7, df=3 and p-value <0.001), household monthly income (X2=5.11, df=2 and P-value <0.05) and distance of health institution from home (x2=16.71, df=3, p-value <0.001) were found to be significantly associated with place of delivery. In agreement with finding from Tigray (8) ANC follow up appeared to be significantly associated with place of delivery (X2=16.25, df=2 and p-value<0.01).
CONCLUSION:
Saving lives of laboring mothers and new born has social, political and economical benefits and working to improve the situation is in need of justified research findings. As the aim of this research project work is to come up with information on prevalence of home delivery, reasons for and associated factors home delivery was found to be less than regional figure and some other in country findings. Wish to give birth with the presence of relatives, short duration of labor, trust on traditional birth attendants (TBAs) and bad behavior of health workers were reasons for home delivery. Mothers educational status, household monthly income, distance of health institution and ANC follow ups were found to be associated with place where delivery was given. Even though the prevalence of home delivery found being less than the regional figure it need attention as the country is with the motto of no delivery related maternal death. In line with giving due emphasis to improve women educational status, household income, practice of ANC follow up and number of health facilities (to shorten distance) further research can be conducted large sample size and association direction indicator statistical computation.
COMPETING INTEREST:
The authors declare that they have no competing interest.
ACKNOWLEDGEMENTS:
The authors would like to acknowledge Hawassa University, Tulla Sub-city administrative offices, data collectors and participants of the study.
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Received on 06.10.2015 Modified on 17.10.2015
Accepted on 05.11.2015 © A&V Publications all right reserved
Asian J. Nur. Edu. and Research. 2016; 6(3): 386-390
DOI: 10.5958/2349-2996.2016.00076.8