Determinants of traditional birth attendants' service utilisation among women of reproductive age, Osun state, Nigeria: a cross-sectional study.

OBJECTIVE

To assess traditional birth attendant (TBA) service utilisation and associated factors among women of reproductive age in Ife Central Local Government Area, Osun State, Nigeria.

DESIGN

A community-based cross-sectional study guided by Andersen's Behavioural Model.

SETTING

Community settings in Ife Central Local Government Area, Osun State, Nigeria.

PARTICIPANTS

Women who had delivered within the preceding 24 months were selected using a multistage sampling technique involving the selection of wards, households, and one eligible woman per household. The calculated minimum sample size was 369 after adjusting for a 10% non-response rate. Of the 366 questionnaires distributed, 316 were completed and analysed, giving a response rate of 86.3%.

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was self-reported ever use of TBA services. Secondary measures comprised associations between TBA service utilisation and prespecified sociodemographic, healthcare access and sociocultural factors. These associations were assessed using χ² tests and multivariable logistic regression at a 5% significance level.

RESULTS

Of the 316 respondents, 61.4% reported ever using TBA services. In bivariate analyses, TBA service utilisation was significantly associated with inadequate transportation access, a non-positive experience with facility-based maternal services, previous denial of services, exclusion from maternal healthcare decision-making, community approval of TBA use and cultural accommodation by TBAs (all p<0.05). In the fully adjusted model, seven factors remained independently associated with TBA service utilisation: age 27-38 years compared with 15-26 years (adjusted OR (AOR)=3.62, 95% CI 1.62 to 8.07), tertiary education compared with no formal or primary education (AOR=0.17, 95% CI 0.04 to 0.65), adequate transportation access (AOR=0.41, 95% CI 0.17 to 0.97), health insurance covering maternity services (AOR=0.24, 95% CI 0.08 to 0.68), a positive experience with facility-based maternal services (AOR=0.21, 95% CI 0.09 to 0.50), previous denial of care (AOR=2.47, 95% CI 1.17 to 5.24) and community approval of TBA use (AOR=2.38, 95% CI 1.06 to 5.36). The model demonstrated acceptable calibration (Hosmer-Lemeshow χ²(8)=7.839, p=0.449), good discrimination (area under the receiver operating characteristic curve=0.836) and no substantial multicollinearity (all variance inflation factors <3.6).

CONCLUSIONS

TBA service utilisation was associated with maternal age, educational attainment, transportation access, health insurance coverage for maternity services, experiences with facility-based maternal services, previous denial of care and community approval of TBA use. These findings highlight the need to improve access to acceptable facility-based maternal healthcare, address barriers to receiving care and incorporate culturally responsive approaches into maternal health services.