Mapping traditional birth attendance in sub-Saharan Africa between 2012 and 2023: analysis of data from demographic and health surveys

Background

Traditional birth attendance (TBA) remains common in Sub-Saharan Africa (SSA), impacting maternal and neonatal mortality rates. This study aimed at producing high-resolution geospatial estimates and identifying predictors of TBA-assisted childbirth in SSA.

Methods

We used the latest Demographic and Health Survey (DHS) data (2012–2023) from 32 SSA countries. Our sample included 231,189 reproductive-aged women who had given live birth to a child within the past 5 years. A multilevel binary logistic regression model was employed to identify the predictors of TBA-assisted childbirth, accounting for individual, household, and community-level factors. Geospatial analysis identified geographic hotspot areas where TBA is most prevalent.

Result

The proportion of TBA-assisted childbirth among reproductive-aged women in SSA was 12.43% (95% CI: 10.02%, 14.84%), ranging from 0.3% (South Africa) to 49.4 % (Chad). Hotspot clusters of TBA-assisted childbirth were found in Chad, Ethiopia, Madagascar, Guinea, and Niger. TBA-assisted childbirth was associated with women with community low women literacy (AOR=2.82; 95% CI; 2.57, 3.09), low household wealth status (AOR=1.42; 95% CI; 1.34, 1.49), and residing in rural areas (AOR=2.95; 95% CI; 2.68, 3.24) or had major problems with distance from the health facilities (AOR=1.22; 95% CI; 1.17, 1.26).

Conclusion

Significant geographic variation in TBA-assisted childbirth among women in SSA indicates the need for targeted health interventions to improve access to skill delivery services and empower women through financial and literacy initiatives.