Determinants of traditional birth attendants' service utilisation among women of reproductive age, Osun state, Nigeria: a cross-sectional study.

OBJECTIVE: To assess traditional birth attendant (TBA) service utilisation and associated factors among women of reproductive age in Ife Central Local Government Area, Osun State, Nigeria. DESIGN: A community-based cross-sectional study guided by Andersen's Behavioural Model. SETTING: Community settings in Ife Central Local Government Area, Osun State, Nigeria. PARTICIPANTS: Women who had delivered within the preceding 24 months were selected using a multistage sampling technique involving the selection of wards, households, and one eligible woman per household. The calculated minimum sample size was 369 after adjusting for a 10% non-response rate. Of the 366 questionnaires distributed, 316 were completed and analysed, giving a response rate of 86.3%. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was self-reported ever use of TBA services. Secondary measures comprised associations between TBA service utilisation and prespecified sociodemographic, healthcare access and sociocultural factors. These associations were assessed using χ² tests and multivariable logistic regression at a 5% significance level. RESULTS: Of the 316 respondents, 61.4% reported ever using TBA services. In bivariate analyses, TBA service utilisation was significantly associated with inadequate transportation access, a non-positive experience with facility-based maternal services, previous denial of services, exclusion from maternal healthcare decision-making, community approval of TBA use and cultural accommodation by TBAs (all p<0.05). In the fully adjusted model, seven factors remained independently associated with TBA service utilisation: age 27-38 years compared with 15-26 years (adjusted OR (AOR)=3.62, 95% CI 1.62 to 8.07), tertiary education compared with no formal or primary education (AOR=0.17, 95% CI 0.04 to 0.65), adequate transportation access (AOR=0.41, 95% CI 0.17 to 0.97), health insurance covering maternity services (AOR=0.24, 95% CI 0.08 to 0.68), a positive experience with facility-based maternal services (AOR=0.21, 95% CI 0.09 to 0.50), previous denial of care (AOR=2.47, 95% CI 1.17 to 5.24) and community approval of TBA use (AOR=2.38, 95% CI 1.06 to 5.36). The model demonstrated acceptable calibration (Hosmer-Lemeshow χ²(8)=7.839, p=0.449), good discrimination (area under the receiver operating characteristic curve=0.836) and no substantial multicollinearity (all variance inflation factors <3.6). CONCLUSIONS: TBA service utilisation was associated with maternal age, educational attainment, transportation access, health insurance coverage for maternity services, experiences with facility-based maternal services, previous denial of care and community approval of TBA use. These findings highlight the need to improve access to acceptable facility-based maternal healthcare, address barriers to receiving care and incorporate culturally responsive approaches into maternal health services.