Geographically weighted regression analysis of cesarean delivery using the Ethiopian Mini Demographic and Health Survey 2019

A justified cesarean delivery plays a major role in reducing maternal and neonatal death in Ethiopia. However, inequalities exist in access to cesarean delivery within the country. Therefore, this study aimed to assess the geographic variations and predictors of cesarean delivery hotspots in Ethiopia using geographically weighted regression analysis. For this study, data from the 2019 Ethiopian Mini Demographic and Health Survey were utilized. Moran's I and Getis-OrdGi* statistics were used to assess the geographical disparities in the occurrence of cesarean deliveries. Subsequently, spatial regression was performed using ordinary least squares regression and geographically weighted regression to predict hotspot areas of cesarean delivery. The prevalence of cesarean delivery in Ethiopia was 6.07% (95% CI: 5.602, 6.538). In this study, Dire Dawa, Hareri, and the southeastern region of Somali were the hotspot areas for cesarean delivery. A higher level of education, multiple births, five or more antenatal care visits, and delivery in private health institutions were statistically significant predictors of cesarean delivery hotspots in Ethiopia. Cesarean delivery in Ethiopia is still underutilized, despite the presence of hotspot areas. Region-specific interventions are necessary, particularly in hotspot areas. Ensuring accessible and equitable cesarean delivery services is crucial, especially in cold spot areas.