Skilled birth attendance and its associated factors in Chad and Nigeria: A multilevel analysis of DHS data

In the year 2020, Worldwide, 211 maternal deaths occurred per 100,000 livebirths. In particular, Chad and Nigeria report extremely high (>1000) maternal mortality. Despite this, there has been limited research on skilled birth attendance (SBA) and its factors in Chad and Nigeria. Therefore, this study aimed to assess the prevalence of SBA and associated factors among women of reproductive age in extremely high maternal mortality countries. This study is a secondary data analysis based on the Demographic and Health Survey Chad 2014-15, Nigeria 2018, involving 52,666 study participants. We used Stata version 17.0 to analyze the data. A mixed-effects binary logistic regression model was employed to account for the hierarchical structure of the data. An odds ratio along with a 95% CI were generated to identify factors associated with SBA. A p-value less than 0.05 was declared as statistically significant. In this study, the prevalence of SBA among reproductive-age women was 41.90% (95% CI: 41.48 - 42.32). ANC visits (AOR = 5.56; 95% CI: 5.03 - 6.14), Primary (AOR = 1.77; 95% CI: 1.62 - 1.95) and secondary education (AOR = 4.06; 95% CI: 3.59 - 4.57), middle (AOR = 1.37; 95% CI: 1.23 - 1.52) and rich (AOR = 2.77; 95% CI: 1.87-2.38) wealth categories, media exposure (AOR = 1.50; 95% CI: 1.38 -1.63), and community-level education (AOR = 2.73; 95% CI: 2.26 - 3.29) were significant factors associated with skilled birth attendance. 41.90% of reproductive-age women had SBA in countries with high burden maternal mortality. Education, wealth index, media exposure, ANC visit, distance to the health facility, and place of residence were factors for the assisted birth attendance. Therefore, the respective country governments should work on women's and community education, extensive ANC visits, and media exposure.