Trends and factors associated with home delivery among Guinean women: A multilevel analysis using data from Demographic and Health Surveys 2005-2018
- 1African Center of Excellence for the Prevention and Control of Transmissible Diseases (CEA-PCMT), University Gamal Abdel Naser, Conakry, Guinea; Maferinyah National Center for Training and Research in Rural Health (CNFRSR), Forecariah, Guinea; Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
- 2Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
- 3Maferinyah National Center for Training and Research in Rural Health (CNFRSR), Forecariah, Guinea; Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
Abstract
Introduction: Home delivery in low-income countries contributes to the high rate of maternal and neonatal mortality. In Guinea, approximately 47.6% of women continue to give birth at home. This study explores the temporal trends and determinants of this practice between 2005 and 2018. Method: We analyzed data from demographic and health surveys (DHS) conducted in Guinea in 2005, 2012, and 2018, covering a total of 21,275 women. Temporal trends across combined waves were analyzed using design-based weighted logistic regression with denormalized survey weights. Contextual determinants for the latest wave (2018 DHS) were assessed using a two-level multilevel mixed-effects logistic regression (melogit) applying Carle’s Method A for weight scaling. To prevent risk overestimation due to high prevalence (>30%), final fixed coefficients were converted into Average Marginal Effects (AMEs) expressed in absolute probability points. Results: The trend in home delivery decreased from 69.07% (CI: 64.97–72.90) in 2005 to 47.44% (CI: 44.78–51.14) in 2018 (p-trend <0.001). In the fully adjusted multilevel model, living in a rural area emerged as one of the strongest contextual correlates, showing a substantial 0.202-point increase in the absolute probability of home delivery (p<0.001). Strong individual socioeconomic and structural barriers persisted: fewer than 4 antenatal care (ANC) visits (+0.138 points; p<0.001), severe distance barriers to health facilities (+0.069 points; p<0.001), and lack of maternal healthcare decision-making autonomy (+0.044 points; p=0.005). Conversely, secondary/higher maternal education (-0.090 points; p=0.002) and higher household wealth indexes (rich tier: – 0.146 points; p<0.001) exerted significant protective effects. Conclusion: Home delivery in Guinea is heavily driven by structural, geographic, and socioeconomic inequities. Targeted policies must prioritise rural areas, improve ANC completion, and enhance maternal autonomy. These findings highlight the need for targeted interventions to facilitate access to maternal health services and encourage births attended by skilled personnel, considering both individual and contextual factors.
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BibTeX
@article{sidibe2026trends,
title = {{Trends and factors associated with home delivery among Guinean women: A multilevel analysis using data from Demographic and Health Surveys 2005-2018}},
author = {Sidikiba Sidibé and Djiba Diakité and Almamy Amara Touré and Aboubacar Sidiki Magassouba and Hadja Fanta Camara and Abdoulaye Sow and Mory Kourouma and Facely Camara and Alexandre Delamou},
journal = {Journal of Interventional Epidemiology and Public Health},
year = {2026},
month = jul,
doi = {10.37432/jieph-d-25-00193},
url = {https://doi.org/10.37432/jieph-d-25-00193},
note = {CC BY},
}
RIS
TY - JOUR
TI - Trends and factors associated with home delivery among Guinean women: A multilevel analysis using data from Demographic and Health Surveys 2005-2018
AU - Sidikiba Sidibé
AU - Djiba Diakité
AU - Almamy Amara Touré
AU - Aboubacar Sidiki Magassouba
AU - Hadja Fanta Camara
AU - Abdoulaye Sow
AU - Mory Kourouma
AU - Facely Camara
AU - Alexandre Delamou
PY - 2026
DA - 2026/07/01
JO - Journal of Interventional Epidemiology and Public Health
DO - 10.37432/jieph-d-25-00193
UR - https://doi.org/10.37432/jieph-d-25-00193
AB - Introduction: Home delivery in low-income countries contributes to the high rate of maternal and neonatal mortality. In Guinea, approximately 47.6% of women continue to give birth at home. This study explores the temporal trends and determinants of this practice between 2005 and 2018. Method: We analyzed data from demographic and health surveys (DHS) conducted in Guinea in 2005, 2012, and 2018, covering a total of 21,275 women. Temporal trends across combined waves were analyzed using design-based weighted logistic regression with denormalized survey weights. Contextual determinants for the latest wave (2018 DHS) were assessed using a two-level multilevel mixed-effects logistic regression (melogit) applying Carle’s Method A for weight scaling. To prevent risk overestimation due to high prevalence (>30%), final fixed coefficients were converted into Average Marginal Effects (AMEs) expressed in absolute probability points. Results: The trend in home delivery decreased from 69.07% (CI: 64.97–72.90) in 2005 to 47.44% (CI: 44.78–51.14) in 2018 (p-trend <0.001). In the fully adjusted multilevel model, living in a rural area emerged as one of the strongest contextual correlates, showing a substantial 0.202-point increase in the absolute probability of home delivery (p<0.001). Strong individual socioeconomic and structural barriers persisted: fewer than 4 antenatal care (ANC) visits (+0.138 points; p<0.001), severe distance barriers to health facilities (+0.069 points; p<0.001), and lack of maternal healthcare decision-making autonomy (+0.044 points; p=0.005). Conversely, secondary/higher maternal education (-0.090 points; p=0.002) and higher household wealth indexes (rich tier: – 0.146 points; p<0.001) exerted significant protective effects. Conclusion: Home delivery in Guinea is heavily driven by structural, geographic, and socioeconomic inequities. Targeted policies must prioritise rural areas, improve ANC completion, and enhance maternal autonomy. These findings highlight the need for targeted interventions to facilitate access to maternal health services and encourage births attended by skilled personnel, considering both individual and contextual factors.
SN - 2664-2824
ER -