Determinants of Health Facility Utilization at Birth in South Sudan

Int J Environ Res Public Health. 2019 Jul 9;16(13):2445. doi: 10.3390/ijerph16132445.


South Sudan has a high maternal mortality ratio estimated at 800 deaths per 100,000 live births. Birth in health facilities with skilled attendants can lower this mortality. In this cross-sectional study, we determined the level and determinants of health facility utilization and skilled birth attendance in Jubek State, South Sudan. Mothers of children aged less than two years were interviewed in their homes. Multivariable regression analysis was performed to determine factors associated with health facility births. Only a quarter of the mothers had given birth at health facilities, 209/810 (25.8%; 95% CI 18.2-35.3) and 207/810 had a skilled birth attendant (defined as either nurse, midwife, clinical officer, or doctor). Factors positively associated with health facility births were four or more antenatal visits (adjusted odds ratio (AOR) 19; 95% CI 6.2, 61), secondary or higher education (AOR 7.9; 95% CI 3, 21), high socio-economic status (AOR 4.5; 95% CI 2.2, 9.4), and being primipara (AOR 2.9; 95% CI 1.5, 5.4). These findings highlight the need for efforts to increase health facility births in South Sudan.

Keywords: South-Sudan; childbirth; health-facility-births; reproductive health; skilled birth attendant.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Birthing Centers / statistics & numerical data*
  • Cross-Sectional Studies
  • Delivery, Obstetric / statistics & numerical data*
  • Female
  • Health Facilities / statistics & numerical data*
  • Humans
  • Midwifery / statistics & numerical data*
  • Odds Ratio
  • Pregnancy
  • Pregnant Women / psychology*
  • Prenatal Care / psychology*
  • Prenatal Care / statistics & numerical data*
  • Socioeconomic Factors
  • South Sudan
  • Young Adult