Factors Influencing Women’s Choice for Place of Child Birth in Rural Ethiopia: A Cross-Sectional Study

Background: Pregnancy and childbirth complications are foremost cause of deaths and incapacity among women of the reproductive age in developing countries. In Ethiopia, nearly a third to a fourth of births occur without the help of a trained birth assistant. Objectives: The aim of this study was to assess the prevalence of institutional delivery and the determinants for choice of place of delivery. Methodology: A cross-sectional study design was employed from June to August 2018 and systematic sampling method used to select eligible respondents. From a total number of 5,398 pregnant women of whom 85% had visted ANC facilities, thestudy recruited 402 mothers aged 25-34 years. These mothers had given birth one year prior to data collection in the Wondo Genet District of Ethiopia. Data was cleansed, coded, entered into Epi Data 3.1 and analyzed using SPSS version 20. Logistic regression was used to identify statistically significant variables for the choice of place for delivery. Results: More than half 216 (53.7%) of the respondents were rural residents and more than onethird 147 (36.6%) were not able to read nor write. From every 10 women, 4 were housewives thus 249 (61.9%). More than 75% of them had access to the media (majorly television and radio) Factors that were statistically significant for the choice place of delivery were primary and above educational status of women, (AOR=0.14, CI, 0.03-0.68), income greater than 3000 ETB (AOR=8.35 CI, 3.6-19.4), four or more ANC frequency (AOR=4.14 CI, 2.0-8.6) and previous planned pregnancy (AOR=4.14 CI, 2.0- 8.6). Conclusion: Prevalence of institutional delivery was 61.2%. This calls for the District Health Committee to work on myth and misconception  surrounding institutional delivery. Appropriate information, education, and communication will be a vital strategy in helping women to take the initiative of visiting health facilities. Educational status and monthly income were statistically important factors in disseminating health information to enhance knowledge of the women. Keywords - institutional delivery, place of childbirth, home delivery, maternal health, Health facility

Prevalence and Determinants of Low Birth Weight in Ethiopia: A Systematic Review and Meta-Analysis

Introduction: Low birth weight was defined as weight at birth less than 2500 grams. This had numerous negative outcomes such as fetal and  neonatal mortality and morbidity. It was estimated that between year 2000 to 2018, twenty million (15% to 20%) of all births worldwide had low birth weight yearly. Data analyzed from the Swedish Childhood Diabetes Register (SCDR) indicated that, low birth weight infants. were 24% higher odds of developing type-1 diabetes, hypertension, obesity and dyslipidemia in future compared to normal birth weight infants. In Ethiopia, the proportion of births weighing less than 2.5 kg at birth in the past three DHS surveys was 14% in 2005, 11% in 2011, and 13% in 2016. That differed with WHO 2025 goal of achieving 30% reduction in the number of infants born with weight lower than 2500g. Objectives: This systematic review study was aimed to explicitly assess and determine the contributing factors of low birth weight in Ethiopia for intervention. Methodology: Cross-sectional, case-control and cohort studies were conducted in English language. A search of studies in the main databases; PubMed, EMBASE, CINAHL, Web of Science, Scopus, and other gray literature sources was conducted. In respect to eligibility criteria, the  investigators included observational studies that had been conducted at a facility setting in different parts of Ethiopia on the prevalence and factors associated with low birth weight, published and accessible from 2000 - 2018 then written in English. Articles with irretrievable full text records with unrelated outcome measures with missing or insufficient outcomes, reviews, commentaries, editorial, case series/reports, and patient stories were excluded. Meta-analyses with random effects, subgroup analyses, and meta-regression were performed. Publication bias was measured using the Egger regression test and visual funnel plot inspection. Pooled odds ratio was done by using RevMan 5.3 software. 16 studies fulfilled the eligibility criteria. Result: The underlying causes were multi-factorial. Antenatal Care(ANC) and pregnancy complication increased the risk of low birth weight of  infants in Ethiopia. Maternal harmful substance exposure(pesticide, noise, radiation and alcohol consumption), undernutrition, infections, poor socioeconomic status, history of chronic diseases, hepatitis B carriers, intrauterine growth restrictions (IUGR) were reported. The pooled prevalence of low birth weight was 18% (95% CI: 13.9%, 22.2%). Gestational age less than 37weeks was (AOR,7.8; 95% CI: 4.7, 12.95), no antenatal care (AOR,3.39; 95% CI: 1.65, 6.98), rural residence (AOR,2.44; 95% CI: 1.94, 3.08) and women with medical illness during pregnancy (AOR,4.36; 95% CI: 2.55, 7.44) that was significantly associated with low birth weight in Ethiopia. Conclusion: The pooled prevalence of low birth weight was high in Ethiopia. Most rural mothers were unable to follow antenatal care and maternal medical illnesses during pregnancy were significantly contributing factors. The meta-regression confirmed that the sample size and the  methodological quality could partially explain the statistical heterogeneity. Recommandations: Almost all these factors can be prevented by scaling up Antenatal Care (ANC) with the help of Community Health Workers/ Volunteers(CHW/Vs), quality health facilities and improve on the socioeconomic status of the population. Policy makers to assimilate and take action  to the multiple abnormalities found by formulating a management plan for patients with multiple organ disease in the maternity mortality reports. Keywords: low birth weight; prematurity; Ethiopia; systematic review; meta-analysi