Determinants of skilled birth attendant delivery among reproductive age women in Lesotho - A multilevel analysis of demographic and health survey data

Q: What is the focus of the study in Lesotho?

The study examines determinants of skilled birth attendant (SBA) delivery among women of reproductive age in Lesotho using 2023–2024 demographic and health survey data.

Q: What data and methods are used to analyze SBA delivery?

It uses a cross-sectional design with nationally representative data of 1,407 women aged 15–49 and applies multilevel logistic regression to estimate adjusted odds ratios and 95% confidence intervals.

Q: Which groups show lower or higher likelihood of SBA delivery?

Women aged 35–49 have lower odds of SBA delivery, and initiating ANC in the third trimester is associated with reduced SBA use. Higher maternal education, wealthier households, and earlier age at first birth are associated with increased SBA delivery.

Sep 29, 2026

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Skilled birth attendant (SBA) delivery is central to reducing maternal mortality, yet in Lesotho maternal mortality remains elevated despite high SBA coverage. This cross-sectional multilevel analysis uses nationally representative 2023–2024 Lesotho Demographic and Health Survey data from 1,407 women aged 15–49. Multilevel logistic regression reports adjusted odds ratios and 95% confidence intervals, with p-values <0.05. SBA use is lower among older women and women initiating ANC in the third trimester, and higher with maternal education, household wealth, and younger age at first birth.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Introduction

OPEN ACCESS Citation: Endale HT, Asefa T, Mengstie TA, Getnet M, Endalew HL, Getahun AB, et al.(2026) Determinants of skilled birth attendant delivery among reproductive age women in Lesotho: A multilevel analysis of demographic and health survey data. PLoS One 21(1): e0340011. [https://doi.org/10.1371/journal](https://doi.org/10.1371/journal). pone.0340011 Editor: Sabita Tuladhar, Donor Organization in Nepal, NEPAL Received: June 23, 2025 Accepted: December 15, 2025 Published: January 6, 2026 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: [https://doi.org/10.1371/journal](https://doi.org/10.1371/journal). pone.0340011 Copyright: © 2026 Endale et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, RESEARCH ARTICLE Determinants of skilled birth attendant delivery among reproductive age women in Lesotho: A multilevel analysis of demographic and health survey data Hiwot Tezera Endale1*, Tseganesh Asefa2, Tiget Ayelgn Mengstie1, Mihret Getnet3,4, Helen Lamesgin Endalew5, Amare Belete Getahun6, Gashaw Dessie1, Thomas Kidanemariam Yewodiaw7, Engidaw Fentahun Enyew8,9 1 Department of Medical Biochemistry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia, 2 Armauer Hansen Research Institute, Addis Ababa, Ethiopia, 3 Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia, 4 Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia, 5 Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia, 6 Department of Anesthesia, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia, 7 Medical Officer at International Medical Corps, Amhara Region Emergency Operation Center, Gondar Field Office, Gondar, Ethiopia, 8 Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia, 9 Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia * [hiwottezera1@gmail.com](hiwottezera1@gmail.com) Abstract Background Skilled birth attendant (SBA) delivery, defined as childbirth assisted by trained healthcare professionals such as doctors, midwives, and nurses, is a cornerstone of the World Health Organization’s Safe Motherhood Initiative to reduce maternal mortality. Despite high SBA coverage in Lesotho, maternal mortality remains elevated. This study aimed to assess the determinants of SBA delivery among reproductive-age women in Lesotho using the 2023–2024 Lesotho Demographic and Health Survey data. Methods A cross-sectional study design was applied using nationally representative data of 1,407 women aged 15–49 years. Multilevel logistic regression models were employed. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were reported, with p-values <0 .05 considered statistically significant. Results Skilled birth attendant (SBA) coverage was 91.8% . Women aged 35–49 had 60% lower odds of SBA delivery (AOR = 0.40; 95% CI: 0. 17, 0.95) . Higher maternal PLOS One | [https://doi.org/10.1371/journal.pone.0340011](https://doi.org/10.1371/journal.pone.0340011) January 6, 2026 1 / 12 which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data availability statement: All relevant data are within the manuscript and its Supporting information files. Funding:

FAQs

What is the focus of the study in Lesotho?

The study examines determinants of skilled birth attendant (SBA) delivery among women of reproductive age in Lesotho using 2023–2024 demographic and health survey data.

What data and methods are used to analyze SBA delivery?

It uses a cross-sectional design with nationally representative data of 1,407 women aged 15–49 and applies multilevel logistic regression to estimate adjusted odds ratios and 95% confidence intervals.

Which groups show lower or higher likelihood of SBA delivery?

Women aged 35–49 have lower odds of SBA delivery, and initiating ANC in the third trimester is associated with reduced SBA use. Higher maternal education, wealthier households, and earlier age at first birth are associated with increased SBA delivery.

Sep 29, 2026

Uploaded by OmBimo