This study included a total of 125,696 women who gave birth in the 5 years preceding each resent survey conducted in East African Countries. The prevalence of Home delivery was wide-ranging among countries in Easter Africa (ranged from 2.85% in Mozambique to 72.5% in Ethiopia). The prevalence of home delivery was associated with respondent’s age group, marital status, educational status, place of residence, living Country, wealth index, media exposure and total children ever born.
The pooled prevalence of home delivery from East African Region is consistent with report of India DHS report (22%), and lower than studies conducted in Nigeria . When compared to the Kenyan, the likelihood of home delivery was 2.24 times higher among Ethiopian. But the likelihood of home delivery was decreased by 98% for Mozambique, 96% for Malawian, 94% for Rwandan, 92 for Burundian, 85% for Zambian, 75% for Comoros, 69% for Zimbabwean, 66% for Ugandan. The geographical locations of studies varied widely with populations with differing background characteristics and social customs. In addition to social determinants, the health service coverage, quality of maternal healthcare services, economical and health policy of the country might have a role in reducing the home delivery .
The likelihood of home delivery was lowered by 16% among women aged 15–19 years and 35–49 years compared to middle age group women (20–35 years). This association is similar with the result of previous study . Qualitative study conducted in Zambia suggested young women and those without experience in childbirth consulted their parents for the place of delivery. Other studies also reported home preference to give birth is more likely among multiparous mothers. This might they believe that they should not be delivered by either a young nurse or a male staff at the clinic . Cross sectional study conducted in Ethiopia  also suggested preference for a health facility delivery was largely due to the understanding that if complications occurred and this was the only place where they could be managed. Hence self-perception, women attitude and fear of complication might be the factors reduce home delivery during the early (young age) and late (advanced age) pregnancies.
Currently unmarried (never married and formerly married) women were more likely to delivery at home as compared to currently married women. Theories linking marital status, pregnancy and birth preparedness indicated that unmarried women faced lack or reduced level of psychosocial support and relationship stability . Pregnant women without marriage might be unplanned and/ or unwanted. On other hand, low social acceptance of unmarried status in that there is still social stigmatism surrounding illegitimate births in many countries. Hence unmarried women may be intrinsically different from married women who may be less empowered, self-isolated or lack of motivation to access the health service [23–25]. All these factors might be increasing the likelihood of home delivery among currently unmarried mothers.
Educated women had less likelihood of home deliver as compared to uneducated women. The result was in line with the individual studies conducted in rural Ethiopia [26–28], Zimbabwe , Nigeria , Ghana [31, 32], Guinea  and Nepal . The reason for this might be due the fact that when mothers are educated it is more is likely to enhance female self-determination, positive attitude, and financial freedom [34, 35]. Furthermore, it is more likely that educated women demand higher quality service and be alert of difficulties during pregnancy as well as child birth. As a result, they are more probable to use maternal health care services unlike that the illiterate one . These could collectively influence mothers’ awareness to seek better maternal health services, including delivering in health facilities.
Women living rural area had as higher odds of home delivery, which is similar to findings in previous studies [23, 28, 31, 37]. Rural residents in Sub Saharan countries have poor access to health care facilities. Moreover, lack of privacy and confidentiality, and negligence in the provision of care during childbirth by skilled birth attendants are the fear of the women . With rural healthcare provider shortages, greater travel distances and very limited access to obstetric care, it could be likely that there would be high risk of home delivery in rural areas.
In compared with women with poorest wealth status, the odds of home delivery were decreased by 26%, 40%, 55% and 73% among women with poorer, middle, richer and richest wealth status, respectively. This result was in agreement with the previous studies [26–28, 31]. Financial capability of families and costs related to transportation may determine the place of delivery. Moreover, women from higher wealth status might be more empowered, participate in decision and seek maternal health service.
Consistent with previous studies [23, 28, 39, 40] our finding suggests that women who exposed to media were 20% lower chances of home delivery in compared with women without media exposure. Media promotion of institutional delivery and danger of home delivery may influence mothers to develop positive behavior towards delivering in a health facility.
The other most significant determinants of home delivery this study was number of children. The likelihood of home delivery was increased by 16% as the number of total children in the household is increased by one child. This finding was in line with previous studies conducted in Ethiopia [23, 28]. Since the women normalize childbirth, they might be less likely to seek care during labor . Literature also indicated women’s previous interactions with health facilities have an influence and poor experiences during past deliveries may discourage women from returning for the next birth [42, 43]. Hence, the less fear of complication, adverse experience of care for women during childbirth could discourage them to use health facility services in subsequent pregnancies. In addition to these, Multiparous mothers who had done their previous deliveries at home might be more likely to deliver at home in their recent pregnancy [44, 45].
This further analysis of data obtained from nationally representative in the East Africa DHS dataset was population-based with high response rate. The sample size used is large enough to detect the association factors with high power of the study. Hence this study is beneficial to inform policymakers and planners for their intervention to line up.
Limitations of the study include as in any cross-sectional nature of the study design the finding from this study may not found a true causal association between the home delivery and covariate. The data was collected based on self-report from mothers within 5 years prior the survey and this could be a potential source of recall bias. There was no information on numerous other important factors of maternal health service use during childbirth including the existence of emergencies during home deliveries that prompt seeking professional assistance and outcomes from past healthcare service use. Additionally, some important factors like antenatal care, obstetric histories are not included in the analysis as there was no similar definition or classification among the included countries. Since some countries have no DHS program, some countries have limited data access, and some excluded due to old survey (more than ten years) the result of this study may not representative of the entire East Africa zone.