Pooled prevalence and determinants of skilled birth attendant delivery in East Africa countries: a multilevel analysis of Demographic and Health Surveys
Authors: Tessema Zemenu Tadesse , Tesema Getayeneh Antehunegn 
Published: November 2020

Abstract
Introduction
Skilled health professional assisted delivery is an effective strategy to reduce maternal and newborn mortality. Skilled assistant delivery can prevent about 16–33% of maternal and newborn mortality. Despite the commitments of the government to assure home free delivery, majority of the births in Sub-Saharan Africa are attended by traditional birth attendants. As to our search of the literature, there is limited evidence on the prevalence and determinants of skilled delivery in East African countries. Therefore, this study aimed to estimate the pooled prevalence and determinants of skilled birth attendant delivery in East Africa Countries.

Methods
Pooled analysis was done based on Demographic and Health Surveys conducted in the 12 East African countries from 2008 to 2017. A total weighted sample of 141,483 women who gave birth during the study period was included in the study. The pooled prevalence of skilled birth attendance was estimated using STATA version 14. Intra-class Correlation Coefficient, Median Odds Ratio, Proportional Change in Variance, and deviance were used for model fitness and comparison. The multilevel multivariable logistic regression model was fitted to identify determinants of skilled birth attendance in the region. Adjusted Odds Ratio with its 95% Confidence Interval was used to declare significant determinants of skilled birth attendants.

Results
The pooled prevalence of skilled birth attendant in East African countries were 67.18% (95% CI:66.98, 67.38) with highest skilled birth attendant in Rwanda (90.68%) and the lowest skilled birth attendant in Tanzania (11.91%). In the Multilevel multivariable logistic regression model; age 15–24 (Adjusted Odds Ratio (AOR) = 1.14, 95%CI:1.09, 1.18), age 25–49(AOR = 1.16, 95%CI:1.10,1.23), primary women education (AOR = 1.57, 95%CI:1.51,1.63), secondary and above women education (AOR = 2.85, 95%CI:1.73,3.01), primary husband education (AOR = 1.11, 95%CI = 1.07,1.15), secondary and above husband education (AOR = 1.46, 95%CI = 1.40,1.53), middle wealth index (AOR = 1.43, 95%CI = 1.38,1.49),rich wealth index (AOR = 2.38, 95%CI = 2.28,2.48), had ANC visit (AOR = 1.68, 95%CI = 1.62,1.73),multiple gestation (AOR = 2.06, 95%CI = 1.90,2.25), parity 2–4(AOR = 0.65, 95%CI = 0.61,0.69), parity 5 + (AOR = 0.44, 95%CI = 0.41,0.47), accessing health care not big problem (AOR = 1.32, 95%CI = 1.28,1.36), residence (AOR = 0.43, 95%CI = 0.41,0.45) and being Burundi resident (AOR = 0.77, 95%CI = 0.70,0.85) were significantly associated with skilled assisted delivery.

Conclusion
Skilled birth attendance at birth in the East Africa countries was low. Maternal age, women and husband education, wealth index, antenatal care visit, multiple gestations, parity, accessing health care, residence, and living countries were major determinants of skilled attendant delivery. Strategies to increase the accessibility and availability of healthcare services, and financial support that targets mothers from poor households and rural residents to use health services will be beneficial. Health education targeting mothers and their partner with no education are vital to increasing their awareness about the importance of skilled birth attendance at birth.