Empirical Investigation of Determinants of Institutional Delivery Among Women in Rural North East Nigeria

Institutional delivery coverage in the North East zone of Nigeria is among the lowest in the country, and identifying the specific determinants of home versus facility delivery in this geopolitical context is essential for targeted intervention design. This study empirically investigated determinants of institutional delivery among recently delivered women in rural communities in Gombe and Yobe States. A community-based cross-sectional analytical study was conducted, enrolling 520 women who had delivered in the preceding 24 months through multistage cluster sampling. Place of delivery and a comprehensive set of potential determinants including maternal education, birth order, distance to facility, antenatal care attendance, husband occupation, perceived quality of facility care, knowledge of danger signs, and cultural delivery preferences were assessed through structured interviewer-administered questionnaires. Binary logistic regression adjusted for clustering was applied. Institutional delivery was achieved in only 31.4 percent of the combined sample. The strongest predictors of institutional delivery were antenatal care attendance of four or more visits (OR 6.1; p < 0.001), secondary or higher maternal education (OR 4.2; p < 0.001), facility birth of preceding child (OR 3.8; p < 0.001), and facility distance below 5 kilometres (OR 3.1; p < 0.001). Cultural preference for traditional birth attendant delivery was expressed by 42.3 percent of home deliverers. The study provides empirical evidence supporting investment in ANC quality improvement, TBA integration into referral pathways, and mobile obstetric care for communities beyond 5 kilometres from facilities in the North East. Keywords: institutional delivery, skilled birth attendance, rural communities, North East Nigeria, determinants