Spatial and multilevel analysis of unskilled birth attendance in Chad Acquah

Acquah et al. BMC Public Health (2022) 22:1561

https://doi.org/10.1186/s12889-022-13972-6

RESEARCH

Spatial and multilevel analysis of unskilled

birth attendance in Chad

Evelyn Acquah1

, Samuel H. Nyarko2

, Ebenezer N. K. Boateng3

, Kwamena Sekyi Dickson4

,

Isaac Yeboah Addo5* and David Adzrago6

Abstract

Background: Unskilled birth attendance is a major public health concern in Sub-Saharan Africa (SSA). Existing stud￾ies are hardly focused on the socio-demographic correlates and geospatial distribution of unskilled birth attendance

in Chad (a country in SSA), although the country has consistently been identifed as having one of the highest preva￾lence of maternal and neonatal deaths in the world. This study aimed to analyse the socio-demographic correlates

and geospatial distribution of unskilled birth attendance in Chad.

Methods: The study is based on the latest Demographic and Health Survey (DHS) data for Chad. A total of 10,745

women aged between 15 and 49 years were included in this study. A multilevel analysis based on logistic regres￾sion was conducted to estimate associations of respondents’ socio-demographic characteristics with unskilled

birth attendance. Geographic Information System (GIS) mapping tools, including Getis-Ord Gi hotspot analysis tool

and geographically weighted regression (GWR) tool, were used to explore areas in Chad with a high prevalence of

unskilled birth attendance.

Results: The fndings show that unskilled birth attendance was spatially clustered in four Chad departments:

Mourtcha, Dar-Tama, Assoungha, and Kimiti, with educational level, occupation, birth desire, birth order, antenatal

care, and community literacy identifed as the spatial predictors of unskilled birth attendance. Higher educational

attainment, higher wealth status, cohabitation, lowest birth order, access to media, not desiring more births, and

higher antenatal care visits were associated with lower odds of unskilled birth attendance at the individual level. On

the other hand, low community literacy level was associated with higher odds of unskilled birth attendance in Chad

whereas the opposite was true for urban residency.

Conclusions: Unskilled birth attendance is spatially clustered in some parts of Chad, and it is associated with various

disadvantaged individual and community level factors. When developing interventions for unskilled birth attendance

in Chad, concerned international bodies, the Chad government, maternal health advocates, and private stakeholders

should consider targeting the high-risk local areas identifed in this study.

Keywords: Geospatial, Unskilled birth attendance, Multilevel analysis, Chad, Traditional birth attendance,

Demographic and Health Surveys (DHS), Social demography, Public health

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Background

Despite a substantial global decline in maternal mor￾tality ratio (number of maternal deaths per 100,000

live births) by 38% between 2000 and 2017, several

countries in Sub-Saharan Africa (SSA) continue to

record high maternal and neonatal deaths as well as

Open Access

*Correspondence: [email protected]

5

Centre for Social Research in Health, The University of New South Wales,

Sydney, Australia

Full list of author information is available at the end of the article