Clustering of Home Delivery in Bangladesh and Its Predictors: Evidence from the Linked Household and Health Facility Level Survey Data

Background Around half of births in Bangladesh occur at home without skilled birth personnel. This study aims to identify the geographical hot spots and cold spots of home delivery in Bangladesh and associated factors. Methods We analyzed data from the 2017/2018 Bangladesh Demographic and Health Survey and the 2017 Bangladesh Health Facility Survey. The outcome variable was home delivery without skilled personnel supervision (yes, no). Explanatory variables included individual, household, community, and healthcare facility factors. Moran’s I was used to determine hot spots and cold spots of home delivery. Geographically weighted regression models were used to identify cluster-specific predictors of home delivery. Results The prevalence of non-supervised and unskilled supervised home delivery was 53.18%. Hot spots of non-supervised and unskilled supervised home delivery were primarily in Dhaka, Khulna, Rajshahi, and Rangpur divisions. Cold spots of home delivery were mainly in Mymensingh and Sylhet divisions. Predictors of higher home births in hot spot areas included women’s illiteracy, lack of formal job engagement, higher number of children ever born, partner’s agriculture occupation, higher community-level illiteracy, and greater distance to the nearest healthcare facility from women’s homes. Conclusions Unskilled supervised home delivery is prevalent in Bangladesh, and the distance between women’s homes and healthcare facilities plays a significant role. Awareness-building programs should emphasize the importance of skilled and supervised hospital deliveries, particularly among the poor and disadvantaged groups. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols NA ### Funding Statement The authors did not receive any funding for this study ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Fatima F and MNK designed the study, performed the data analysis, and wrote the first draft of this manuscript. Khanam SJ, Rahman MM, and Kabir MI reviewed and edited the previous versions of this manuscript. All authors approved this final version of the manuscript. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable The data supporting the findings of this study are accessible through Demographic and Health Survey but are not publicly available. Researchers interested in accessing the dataset can do so by submitting a research proposal to Demographic and Health Survey, similar to the process we followed to obtain the dataset for this study. The dataset can be accessed at . Interested researchers can apply to access the datasets at .