Institutional Delivery Service Utilization and Associated Factors in Ethiopia: A Systematic Review and Meta Analysis

Abstract Background: Different primary studies in Ethiopia showed the weight of institutional delivery service utilization and the factors associated with it. However, variation among those studies was seen. This study was aimed to estimate the pooled national prevalence and associated factors of Institutional delivery service utilization in Ethiopia. Methods: PubMed, Cochrane library, Web of Science, and Google Scholar were searched. A funnel plot and Egger’s regression test were used to see publication bias. I-squared statistic was applied to check heterogeneity of studies. A weighted Dersimonian laired random effect model was applied to estimate the pooled national prevalence and the effect size of associated factors. Result: A total of twenty four studies were included in this review. The pooled prevalence of Institutional delivery service utilization was 31% (95% Confidence interval (CI): 30%, 31.2%; I 2 = 0.00%). Attitude towards institutional delivery of 3 studies(Adjusted Odd Ratio (AOR)=2.83; 95% CI 1.35,5.92 ), maternal age at first pregnancy of 4 studies(AOR= 3.59; 95% CI 2.27,5.69 ), residence setting of 7 studies (AOR= 3.84; 95% CI 1.31, 11.25), educational status of 5 studies(AOR=2.91;95% 1.88,4.52), availability of information source of 6 studies(AOR= 1.80;95% CI 1.16,2.78), ANC follow-up of 13 studies((AOR= 2.57 95% CI 1.46,4.54 )), frequency of ANC follow up of 4 studies(AOR= 4.04;95% CI 1.21,13.46), knowledge of institutional delivery & danger signs during pregnancy of 11 studies((AOR=3.04;95% CI 1.76 ,5.24 )) and place of birth the most recent birth of 4 studies(AOR=8.44;95% CI 5.75,12.39) were identified factors of institutional delivery service utilization. Conclusions: The findings of this review found several modifiable factors such as empowering women through education, promoting antenatal care to prevent home delivery, increasing awareness of women through mass media and making services more accessible would likely to increase utilization of institutional delivery.