Individual and Contextual Factors Associated with Skilled Birth Attendance in Kogi State, Nigeria: Evidence from the 2021 Multiple Indicator Cluster Survey

Abstract

Skilled birth attendance (SBA) is a core indicator of progress toward reducing maternal and newborn mortality, yet substantial subnational disparities persist across Nigeria, and evidence specific to Kogi State remains scarce. This study analyzed data on women aged 15–49 years with a live birth in the two years preceding the 2021 Nigeria Multiple Indicator Cluster Survey (MICS6), restricted to the Kogi State subsample (n = 155). Survey-weighted prevalence was estimated, and multilevel logistic regression models with a random intercept for PSU were fitted to identify correlates of SBA, with model selection guided by AIC, BIC, and likelihood-ratio comparison; a survey-weighted regression served as a sensitivity check. Weighted SBA prevalence was 73.5% (95% CI: 58.8–84.3%), rising from 52.6% in poorer households to 93.7% in richer households, and higher in urban (93.1%) than rural areas (59.5%). A model containing residence, wealth, and household size (Model 2) provided the best fit (AIC = 175.69, BIC = 193.95). Women in richer households had substantially higher odds of SBA than those in poorer households (adjusted odds ratio [AOR] = 6.14, 95% CI: 1.60–23.48), while rural residence and household size were not independently associated with SBA after adjustment, though the small sample limits precision. Meaningful between-cluster variation was observed (ICC = 0.215, MOR = 2.47), and the sensitivity analysis produced directionally consistent estimates. Household wealth is the dominant correlate of SBA in Kogi State; interventions reducing financial and geographic barriers for poorer and rural households are likely to yield the largest gains in SBA coverage.