Prevalence of home births assisted by traditional birth attendants and associated factors among mothers 15- 49 years in Lira district, Uganda.

Abstract

Home births, which occur outside formal health facilities and are often attended by traditional birth attendants (TBAs), remain a major public health concern, particularly in rural areas. They are associated with poor maternal and neonatal outcomes and continue to contribute to Uganda’s high maternal mortality. Despite ongoing efforts to promote facility-based deliveries, a considerable proportion of women still give birth at home. This study aimed to determine the prevalence and identify factors associated with home births among mothers in Lira District, northern Uganda. Methods:A cross-sectional study was conducted among women aged 15–49 years who had delivered within the six months preceding the survey. A multistage sampling approach was used to select 267 participants. Quantitative data were collected using semi-structured questionnaires, and qualitative insights were obtained through interviews with nine key informants. Quantitative data were analyzed using STATA software, employing modified Poisson regression to identify factors associated with home births.Results:Of the 267 respondents, the mean age was 28.3 years (SD±7.2), most were married (81.2%), and the majority had attained primary education (70.6%). The prevalence of home births assisted by TBAs was 23.3%. Education level was strongly associated with delivery location: women with primary education had a 30% lower prevalence of home birth compared to those with no education (APR = 0.70; 95% CI: 0.61,0.80), while those with secondary education had a 32% lower prevalence (APR = 0.68; 95% CI: 0.59, 0.79). Single mothers had a 32% higher prevalence of home birth compared to married women (APR = 1.32; 95% CI: 1.19, 1.51), and widowed mothers had a 21% higher prevalence. (APR = 1.21; 95% CI: 1.03, 1.42). Higher parity was associated with a lower prevalence of home birth compared to primiparous women (two births: APR = 0.88; 95% CI: 0.79, 0.99; three births: APR = 0.83; 95% CI: 0.74-0.92; four or more births: APR = 0.85; 95% CI: 0.76, 0.95). Fewer antenatal care visits were associated with a higher prevalence of home birth. Women who attended one ANC visit had a 26% higher prevalence of home births compared to those who attended four or more visits (APR = 1.26; 95% CI: 1.09, 1.46).Conclusion: More than two in ten women in Lira district delivered at home with the assistance of TBAs. Lower education, limited availability of health workers, and inadequate ANC attendance were key drivers of home births, while higher parity appeared protective. Strengthening maternal health education and improving ANC quality and accessibility remain essential to reduce TBA-assisted home births and enhance health facility utilization in similar rural settings.