A total of 7193 mothers were eligible. Out of those mothers, 256 (1.9% weighted by region) were undergoing CS. Average maternal age was 29.26 years, 80% of mothers having more than one children, 8.85% mothers had a history of abortion. Of mothers had a history of abortion, 4.87% were undergoing to CS.
Among mothers undergoing to CS, 54.29% were orthodox, 33.20% were primary school educated, 12.11% had a history of abortion, 9.37% had taken the drug for intestinal disease during pregnancy and 93.75% had multiple pregnancy. (See Table in the appendix 1). Regarding level-2 factors, 21.9% were residing in Addis Abeba. 12.7% residing from urban areas. (See Table 2).
Among 6937 vaginal delivered mothers, 4317(62.23%), 2411(34.76%) and 6331(91.26%) weren't educated, from poorest household and hadn't history of abortion, respectively.
Bivariate analysis of factors associated with CS were conducted. See Table 1 in the appendix and Table 2.
Multivarable multilevel logistic regression analysis of CS
Measure of association and random intercepts for CS are presented Table 3 in the appendix. The results of the empty model (Model_1) indicated that there was a significant variation of CS between level-2 factors (random intercept variance = 1.064, p-value = 0.000).
Similarly, the ICC in the empty model implied that 24.44 % of the total variance in mode of delivery was credited to differences between level-2 factors.
In Model_2 only level-1 variables were added. With this, maternal education, multiple pregnancy, preceding birth interval, place of delivery, size of the child, parity and household wealth index were significantly associated with CS. ICC in Model_2 indicated that, 23.33% of the variation of CS were accountable to differences across levels-2 factors. As shown by a PCV, 5.9% of the variance in CS across the level-2 was explained by level-1 characteristics.
Model_3, only level-2 factors were added. The result revealed that a woman residing in a rural community was significantly associated with CS. In addition to this; a woman from Somali, Gammbella, Harreri, Addis Abeba and Dire Dewa regions were significantly associated with CS. The ICC showed that differences between level-2 factors account 23.98% of the variation of CS. In addition, PCV indicated that 3.7% of variation of CS explained by level-2 characteristics.
Model_4, the final model included both level-1 and level-2 factors simultaneously which have a p-value less than 0.1 from bivariable analysis. The estimated ICC, 23.35% of the variability in CS were accountable to differences between level-2 factors. PCV indicated that, 3.5% of variation of CS across level-2 explained by both level-1 and level-2 factors. After adjusting the other level-1 and level-2 factors; maternal education, preceding birth interval, place of delivery, multiple pregnancy, size of child, parity and household wealth index in level-1 and also residence and region (Gambella, Hareri, Addis Abeba and Dire Dewa) in level-2 were significantly associated with CS.
The odds of a mother having higher education, undergoing to CS were 9% (AOR= 1.09, 95% CI:1.07, 1.12) more likely compared to mothers who hadn't educated. The odds of experiencing CS were 1.01 (AOR= 1.01; 95% CI: 1.00. 1.03) times more likely for one month increases.
Regarding a woman having multiple pregnancy was 11% (AOR=1.11; 95% CI: 1.08, 1.15) more likely to give birth by CS. Likewise, a woman in public, private and NGO health institution was 1.04(AOR=1.04; 95% CI: 1.03, 1.05), 1.29(AOR=1.29; 95% CI: 1.25, 1.32), 1.07(AOR=1.07; 95% CI: 1.02, 1.12) ,1.09(AOR=1.09; 95% CI: 1.05, 1.130) times more likely undergoing to CS as compared to home delivery, respectively. A woman having large child size more likely deliver by CS than medium (AOR=1.01; 95% CI:1.001, 1.02). A woman having between two and five children was 2% (AOR=0.98; 95% CI:0.97, 0.99) less likely undergoing to CS as compared to having a primary child.
The odds of a woman from the richest households were 2% (AOR = 0.98; 95% CI: 0.97, 0.99) less likely undergoing to CS as compared to a woman from the poorest households. Similarly a woman in rural residence was 2% (AOR = 0.98 95% CI:0.96, 0.99) less likely to give birth by CS as compared to urban counterparts. Looking Region, a woman residing from Harerri had 2 % (AOR= 0.98; 95% CI: 0.96,0.99) less likely undergoing to CS compared with Tigray. The odds of a woman from Gambella, Addis Abeba and Diere Dewa having more likely undergoing to CS than a woman from Tigray (AOR=1.02; 95% CI:1.01,1.04), AOR=1.06; 95% CI: 1.04,1.09) and AOR =1.08; 95% CI: 1.06,1.11) respectively. See Table 3 in the Appendix.