Trends, spatial distribution and determinants of maternal home deliveries in Zambia.
Background: The absence of skilled care during home deliveries represents a critical public health concern, as it has a significant impact on maternal mortality rates. The World Health Organization (WHO) reports that approximately 287,000 women worldwide died in 2020 due to maternal causes, equating to more than 800 maternal deaths each day. The study aimed at analyzing trends, spatial distribution and determinants of maternal home deliveries in Zambia between 1992 and 2018.
Methods: The study used data from six rounds of the Zambia Demographic and Health Survey (ZDHS). A weighted sample of 6,230 women in 1992, 7,136 in 1996, 6,594 in 2001/02, 13,211 in 2013/14 and 9,731 in 2018 who delivered at home or health facility five years preceding the survey. Univariate and bivariate analyses were employed to examine trends in maternal home deliveries based on selected individual and community-level factors from 1992 to 2018.Spatial analysis was used to highlight regional disparities in maternal home births. The multilevel logistic regression model was used to analyze the potential predictors of maternal home deliveries using STATA version 15.
Results: The prevalence of maternal home deliveries in Zambia decreased from 49% in 1992 to 15% in 2018. Spatial analysis showed regional variations, with the Northern province consistently having the highest prevalence of home births. Multilevel logistic regression highlighted the influence of individual and selected community factors of home deliveries. The results show that women with primary, secondary, and higher education had significantly reduced odds of delivering at home compared to women with no education from 1992 to 2018. In 2018, women with primary, secondary, and higher education had a 35%, 62%, and 96% reduction in the odds of delivering at home compared to women with no education [aOR = 0.65, 95% CI: 0.49-0.88; aOR = 0.38, 95% CI: 0.26-0.56; aOR = 0.04, 95% CI: 0.01-0.74]. Women in middle and rich quintile, attending at least one antenatal care reduced the likelihood of delivering at home. In terms of selected community factors, women from rural residence had increased odds of home delivery across all the survey years.
Conclusions: Despite a decline in maternal home deliveries, rural women continue to choose this option due to factors such as lack of education, higher parity, limited media exposure, and inadequate antenatal care. Regional and community variations also influence these choices. These findings can guide health policy by targeting interventions in rural areas, improving education, and enhancing access to antenatal care to reduce home deliveries and improve maternal health outcomes.