Spatial Distribution and Determinants of Unskilled Birth Attendance in Ethiopia: Spatial and Multilevel Analysis

Abstract Introduction: Deliveries performed by unskilled birth attendants contribute to maternal and newborn deaths in low-and middle-income countries such as Ethiopia, where only 28% of women give birth by skilled health personnel. Hence, this study was aimed to examine spatial variation and associated factors of unskilled birth attendance in Ethiopia. Methods: This study used a total weighted sample of 7579 women who had a live birth in the five years preceding the survey obtained from 2016 EDHS data were included in the analysis. ArcGIS 10.7 software was used to detect areas with a high prevalence of unskilled birth attendance in Ethiopia. Besides, a multilevel binary logistic regression analysis was done to identify the determinant factors of UBA delivery. Results: Based on the 2016 EDHS, the overall national prevalence of unskilled birth attendants was more than three-fourth (66.93 %) with 95% CI (66.39, 69.12 66.93 %). In the multivariable multilevel binary logistic regression model; women age group, women attained primary and above educational level, women in the middle and richest household wealth status, mass media exposure, ANC visits, region, place of residence and health insurance coverage were significantly associated with unskilled birth attendance. The spatial distribution analysis of unskilled birth attendant was significantly varied across the country with the significant hotspot areas in the eastern Somali, western Gambela, central and eastern Amhara, southwestern Oromia, eastern border of SNNP region were detected. Conclusion: The national prevalence of unskilled birth attendance delivery in Ethiopia was still more than three-fourth. The geospatial distribution of UBAs was varied across the country. Maternal age group, education level, rural residence, ANC visits, mass media exposure, wealth status, health insurance coverage and barriers in accessing healthcareservice were determinants of unskilled birth attendants. Hence, improving maternal educational level, special interventional design in hotspot areas, and motivate the women to take antenatal care is vital to decrease the prevalence of unskilled attendance delivery.