Trends and factors associated with home delivery among Guinean women: A multilevel analysis using data from Demographic and Health Surveys 2005-2018

Introduction: Home delivery in low-income countries contributes to the high rate of maternal and neonatal mortality. In Guinea, approximately 47.6% of women continue to give birth at home. This study explores the temporal trends and determinants of this practice between 2005 and 2018. Method: We analyzed data from demographic and health surveys (DHS) conducted in Guinea in 2005, 2012, and 2018, covering a total of 21,275 women. Temporal trends across combined waves were analyzed using design-based weighted logistic regression with denormalized survey weights. Contextual determinants for the latest wave (2018 DHS) were assessed using a two-level multilevel mixed-effects logistic regression (melogit) applying Carle’s Method A for weight scaling. To prevent risk overestimation due to high prevalence (>30%), final fixed coefficients were converted into Average Marginal Effects (AMEs) expressed in absolute probability points. Results: The trend in home delivery decreased from 69.07% (CI: 64.97–72.90) in 2005 to 47.44% (CI: 44.78–51.14) in 2018 (p-trend <0.001). In the fully adjusted multilevel model, living in a rural area emerged as one of the strongest contextual correlates, showing a substantial 0.202-point increase in the absolute probability of home delivery (p<0.001). Strong individual socioeconomic and structural barriers persisted: fewer than 4 antenatal care (ANC) visits (+0.138 points; p<0.001), severe distance barriers to health facilities (+0.069 points; p<0.001), and lack of maternal healthcare decision-making autonomy (+0.044 points; p=0.005). Conversely, secondary/higher maternal education (-0.090 points; p=0.002) and higher household wealth indexes (rich tier: – 0.146 points; p<0.001) exerted significant protective effects. Conclusion: Home delivery in Guinea is heavily driven by structural, geographic, and socioeconomic inequities. Targeted policies must prioritise rural areas, improve ANC completion, and enhance maternal autonomy. These findings highlight the need for targeted interventions to facilitate access to maternal health services and encourage births attended by skilled personnel, considering both individual and contextual factors.