Spatial Distribution and Determinants of Caesarean Section Delivery in Ethiopia: a Spatial and Multilevel Analysis EDHS 2019

Introduction: Assessing the spatial distribution of caesarean section (CS) is important in developing an effective intervention. However, there is no spatial analysis of the distribution of CS in Ethiopia. Therefore, this study aims to investigate the spatial distribution and the determinants of CS delivery in Ethiopia. Methods: The Bernoulli model was applied using SaTScan V.9.6. Geospatial patterns and prediction of CS delivery in unsampled areas were mapped using ArcGISV.10.8. A multilevel regression model was fitted. The adjusted odds ratio was reported by 95% CI and a p-value<0.05 was declared a statistically significant factor. Result: In Ethiopia, the prevalence of CS delivery was 5.44 %( 95% CI: 4.9-6). Spatial clustering CS was observed in Addis Ababa and Dire Dawa. In the multilevel analysis, rural settlement (AOR=1.98; 95% CI: 1.02 to 3.86), the primary (AOR= 2.41; 95% CI: 1.67 to 3.47), the secondary (AOR= 3.61; 95% CI: 2.19 to 5.94) and higher education (AOR= 3.80, 95% CI: 2.11 to 6.85), rich wealth status (AOR=1.66, 95% CI: 1.06-2.59), and twin birth (AOR= 7.32; 95% CI: 4.13-12.99) were significantly associated with CS. Conclusion and recommendation: Significant spatial variation had seen in Ethiopia. Therefore, reducing the unnecessary use of CS delivery should be improved in the hotspot areas. Keywords: Caesarean section, spatial analysis, Multilevel, Ethiopia