ArticleGlobal health research and policy2025
Global dominance of non-institutional delivery and the risky impact on maternal mortality spike in 25 Sub-Saharan African Countries.
Article in Global health research and policy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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6 citing papers in PubMed.
- Financing of Trauma and Burn Prevention and Care in Malawi: A Scoping Review.Health science reports · 2026Review
- Dynamics of Mpox epidemics by the interplay of COVID-19 pandemic in Africa.BMC medicine · 2026Article
- Maternal Mortality Among Black Women in Brazil: A Retrospective Cohort Study.International journal of environmental research and public health · 2026Article
- Perspectives and lived experiences of postpartum women seeking health services from traditional birth attendants (TBAs) in Mayuge District, Eastern Uganda.Discover social science and health · 2026Article
- Prevalence and Determinants of Facility Delivery Among Women in Somalia: Insights from the 2020 Somali Demographic and Health Survey (SDHS).International journal of women's health · 2026Article
- Skilled birth attendance and its associated factors in Chad and Nigeria: A multilevel analysis of DHS data.PLOS global public health · 2025Article
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Abstract
backgroundDespite 70% of global maternal death occurring in Sub-Saharan Africa (SSA) and the high rate of non-institutional delivery (NID), studies that inspect the connections are needed but lacking. Thus, we investigated the urban-rural burden and risk factors of NID and the correlate with maternal mortality to extend strategies for sinking the mortality spike towards sustainable development goal (SDG-3.1) in SSA.
methodsSecondary analysis of recent (2014-2021) cross-sectional demographic-health-survey (DHS) were conducted across 25-countries in SSA. Primary outcome was institutional versus non-institutional delivery and secondary outcome was maternal-mortality-ratio (MMR) per 100,000 livebirths and the lifetime risk (LTR), while predictors were grouped by socio-economic, obstetrics and country-level factors. Data were weighted to adjust for heterogeneity and descriptive analysis was performed. Pearson chi-square, correlation, and simple linear regression anlyses were performed to assess relationships. Multivariable logistic regression further evaluated the predictor likelihood and significance at alpha = 5% (95% confidence-interval 'CI').
resultsPrevalence of NID was highest in Chad (78.6%), Madagascar (60.6%), then Nigeria (60.4%) and Angola (54.3%), with rural SSA dominating NID rate by about 85%. Odds of NID were significantly lower by 60% and 98% among women who had at least four antenatal care (ANC) visits (aOR = 0.40, 95%CI = 0.38-0.41) and utilized skilled birth attendants (SBA) at delivery (aOR = 0.02, 95%CI = 0.01-0.02), respectively. The odds of NID reduces by women age, educational-level, and wealth-quintiles. Positive and significant linear relationship exist between NID and MMR (ρ = 0.5453), and NID and LTR (ρ = 0.6136). Consequently, 1% increase in NID will lead to about 248/100000 and 8.2/1000 increase in MMR and LTR in SSA respectively.
conclusionsOnly South Africa, Rwanda and Malawi had achieved the WHO 90% coverage for healthcare delivery. ANC and SBA use reduced NID likelihood but, MMR is significantly influenced by NID. Hence, strategic decline in NID will proportionately influence the sinking of MMR spike to attain SDG-3.1 in SSA.
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