{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T18:09:05Z","timestamp":1790014145439,"version":"4.0.1"},"reference-count":47,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Bangladesh has achieved notable progress in maternal and child health; however, maternal and neonatal mortality remain high, partly due to inadequate access to skilled birth attendants (SBA) during delivery. This study aims to identify key socioeconomic and demographic factors influencing SBA utilization in Bangladesh.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were obtained from the 2022 Bangladesh Demographic and Health Survey (BDHS), a nationally representative cross-sectional survey which was conducted from June 27 to December 12, 2022. The outcome variable was skilled birth attendants during delivery, defined as attendants provided by a doctor, nurse, or midwife. Descriptive statistics and chi-square tests were used for initial analysis, followed by binary logistic regression to identify significant determinants. Additionally, the inclusion of machine learning models provides an additional classification framework that improves classification performance and helps identify important predictors, complementing traditional regression analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From the study, 67.94% of women utilized skilled birth attendants during childbirth. Higher maternal education, household wealth, antenatal care utilization, and urban residence were significantly associated with greater SBA utilization. Women with higher education had substantially higher odds of using SBA than those with no education (AOR = 4.10, 95% CI: 1.94\u20138.66, p &lt; 0.001), while rural women had lower odds than urban women (AOR = 0.64, 95% CI: 0.47\u20130.88, p = 0.006). Women who attended four or more ANC visits were also more likely to use SBA than those with no ANC visits (AOR = 2.92, 95% CI: 1.72\u20134.96, p &lt; 0.001). Women from the richest households had higher odds of SBA utilization compared with those from the poorest households (AOR = 1.77, 95% CI: 1.11\u20132.81, p = 0.016). Among the machine-learning models, Random Forest achieved the highest numerical accuracy (0.82).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Education, economic status, ANC utilization, and place of residence were identified as key factors associated with skilled birth attendants during delivery in Bangladesh using the binary logistic regression model. Moreover, the machine learning models were used separately to classify SBA. Targeted interventions focusing on disadvantaged and rural populations can help improve equitable access to maternal healthcare. However, differences related to religion and region should be interpreted cautiously, as they may reflect broader socioeconomic and cultural factors rather than direct effects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0358556","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:28:20Z","timestamp":1790011700000},"page":"e0358556","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence and associated factors of skilled birth attendants in Bangladesh: A combined statistical and machine learning analysis"],"prefix":"10.1371","volume":"21","author":[{"given":"Jakia Sultana","family":"Mim","sequence":"first","affiliation":[{"name":"Shahjalal University of Science and Technology","place":["Sylhet, Bangladesh"],"department":["Department of Statistics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md. Shihab","family":"Mostafa","sequence":"additional","affiliation":[{"name":"Shahjalal University of Science and Technology","place":["Sylhet, Bangladesh"],"department":["Department of Statistics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1708-0391","authenticated-orcid":true,"given":"Bodrunnahar","family":"Barna","sequence":"additional","affiliation":[{"name":"Shahjalal University of Science and Technology","place":["Sylhet, Bangladesh"],"department":["Department of Statistics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Nuzat","family":"Sadia","sequence":"additional","affiliation":[{"name":"Shahjalal University of Science and Technology","place":["Sylhet, Bangladesh"],"department":["Department of Statistics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raisul","family":"Islam","sequence":"additional","affiliation":[{"name":"Shahjalal University of Science and Technology","place":["Sylhet, Bangladesh"],"department":["Department of Statistics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3398-6907","authenticated-orcid":true,"given":"Abdullah Al","family":"Islam","sequence":"additional","affiliation":[{"name":"Shahjalal University of Science and Technology","place":["Sylhet, Bangladesh"],"department":["Department of Statistics"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"pone.0358556.ref001","doi-asserted-by":"crossref","first-page":"104140","DOI":"10.1016\/j.midw.2024.104140","article-title":"Investigating the role of women\u2019s education status and empowerment on accessing skilled birth attendance in Bangladesh: A structural equation modelling approach","volume":"138","author":"J Bhowmik","year":"2024","journal-title":"Midwifery"},{"key":"pone.0358556.ref002","doi-asserted-by":"crossref","first-page":"226","DOI":"10.12691\/ajphr-1-8-6","article-title":"Socio-demographic Factors Associated with Home Delivery Assisted by Untrained Traditional Birth Attendant in Rural Bangladesh","volume":"1","author":"MH Chowdhury","year":"2013","journal-title":"Am J Public Health Res"},{"key":"pone.0358556.ref003","article-title":"Utilization of skilled birth attendant in the South Asian region: A comparative study of India, Bangladesh and Nepal","author":"A Anand","journal-title":"Utilization of skilled birth attendant in South Asian region: A comparative study of India, Bangladesh and Nepal"},{"issue":"9832","key":"pone.0358556.ref004","doi-asserted-by":"crossref","first-page":"2206","DOI":"10.1016\/S0140-6736(12)60685-0","article-title":"From millennium development goals to sustainable development goals","volume":"379","author":"JD Sachs","year":"2012","journal-title":"Lancet"},{"key":"pone.0358556.ref005","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1186\/1742-4755-11-86","article-title":"Practices and determinants of delivery by skilled birth attendants in Bangladesh","volume":"11","author":"N Islam","year":"2014","journal-title":"Reprod Health"},{"key":"pone.0358556.ref006","article-title":"Rural-urban determinants of receiving skilled birth attendants among women in Bangladesh: evidence from national survey 2017-18","author":"S Afroja","year":"2022","journal-title":"Int J Clin Pract"},{"key":"pone.0358556.ref007","author":"Improving Birth Outcomes","year":"2003"},{"issue":"2","key":"pone.0358556.ref008","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1007\/s10389-023-01966-6","article-title":"Skilled birth attendants and caesarean sections: a case in Bangladesh","volume":"33","author":"MI Alam","year":"2023","journal-title":"J Public Health (Berl)"},{"key":"pone.0358556.ref009","article-title":"Neonatal infectious disease: A major contributor to infant mortality requiring advances in point-of-care diagnosis","author":"M Garvey","year":"2024","journal-title":"Antibiotics"},{"key":"pone.0358556.ref010"},{"key":"pone.0358556.ref011"},{"key":"pone.0358556.ref012"},{"key":"pone.0358556.ref013","unstructured":"Maternal mortality ratio (per 100,000 live births). World Bank Gender Data Portal. https:\/\/liveprod.worldbank.org\/en\/indicator\/sh-sta-mmrt. Accessed 2025 May 16."},{"key":"pone.0358556.ref014","unstructured":"Progress and highlights in 2022 maternal and perinatal death surveillance and response (MPDSR) in Bangladesh. 2022."},{"issue":"6","key":"pone.0358556.ref015","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0267660","article-title":"Individual and community-level factors associated with skilled birth attendants during delivery in Bangladesh: A multilevel analysis of demographic and health surveys","volume":"17","author":"MT Nahar","year":"2022","journal-title":"PLoS One"},{"issue":"9","key":"pone.0358556.ref016","article-title":"Two level logistic regression analysis of factors influencing skilled birth attendant during delivery among Bangladeshi mothers: A nationally representative sample","volume":"18","author":"NJ Ema","year":"2023","journal-title":"PLoS One"},{"issue":"1","key":"pone.0358556.ref017","article-title":"The role of individual and community empowerment as drivers of contraceptive use among reproductive aged women in Bangladesh: Insights from multilevel analysis using BDHS 2022","volume":"21","author":"B Pal","year":"2026","journal-title":"PLoS One"},{"issue":"1","key":"pone.0358556.ref018","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1186\/s12905-023-02825-y","article-title":"Effectiveness of mobile technology and utilization of maternal and neonatal healthcare in low and middle-income countries (LMICs): a systematic review","volume":"23","author":"P De","year":"2023","journal-title":"BMC Womens Health"},{"key":"pone.0358556.ref019"},{"key":"pone.0358556.ref020"},{"key":"pone.0358556.ref021","year":"2023","journal-title":"Built Environment through a Well-being Lens. OECD Publishing"},{"key":"pone.0358556.ref022","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/1751-0473-3-17","article-title":"Purposeful selection of variables in logistic regression","volume":"3","author":"Z Bursac","year":"2008","journal-title":"Source Code Biol Med"},{"key":"pone.0358556.ref023"},{"key":"pone.0358556.ref024"},{"key":"pone.0358556.ref025"},{"key":"pone.0358556.ref026","unstructured":"Births attended by skilled health staff (% of total) - Nepal. https:\/\/data.worldbank.org\/indicator\/SH.STA.BRTC.ZS?locations=NP. Accessed 2025 May 16."},{"key":"pone.0358556.ref027"},{"key":"pone.0358556.ref028","first-page":"249","author":"N Nasrat","year":"2021"},{"key":"pone.0358556.ref029","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph22111691","article-title":"Identifying predictors of utilization of skilled birth attendance in Uganda through interpretable machine learning","author":"SM Memon","year":"2025"},{"key":"pone.0358556.ref030","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.puhe.2019.02.027","article-title":"Antenatal care and skilled birth attendance in Bangladesh are influenced by female education and family affordability: BDHS 2014","volume":"170","author":"J Bhowmik","year":"2019","journal-title":"Public Health"},{"key":"pone.0358556.ref031","author":"A Anand"},{"issue":"4","key":"pone.0358556.ref032","doi-asserted-by":"crossref","first-page":"252","DOI":"10.2471\/BLT.07.042754","article-title":"Inequity in maternal health-care services: evidence from home-based skilled-birth-attendant programmes in Bangladesh","volume":"86","author":"I Anwar","year":"2008","journal-title":"Bull World Health Organ"},{"issue":"1","key":"pone.0358556.ref033","doi-asserted-by":"crossref","first-page":"142","DOI":"10.2105\/AJPH.2006.104265","article-title":"Equity of skilled birth attendant utilization in developing countries: financing and policy determinants","volume":"98","author":"ME Kruk","year":"2008","journal-title":"Am J Public Health"},{"issue":"1","key":"pone.0358556.ref034","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1186\/s12978-021-01124-9","article-title":"Predictors of skilled birth attendance among married women in Cameroon: further analysis of 2018 Cameroon Demographic and Health Survey","volume":"18","author":"S Yaya","year":"2021","journal-title":"Reprod Health"},{"issue":"2","key":"pone.0358556.ref035","article-title":"Inequality of the use of skilled birth assistance among rural women in Bangladesh: facts and factors","volume":"27","author":"SMM Kamal","year":"2015","journal-title":"Asia Pac J Public Health"},{"key":"pone.0358556.ref036","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s40748-017-0046-0","article-title":"Factors affecting deliveries attended by skilled birth attendants in Bangladesh","volume":"3","author":"GMA Kibria","year":"2017","journal-title":"Matern Health Neonatol Perinatol"},{"key":"pone.0358556.ref037","doi-asserted-by":"crossref","first-page":"23","DOI":"10.3329\/bjsr.v30i1-2.36117","article-title":"Importance of maternal education on antenatal care visits in Bangladesh","volume":"30","author":"KA Mohammad","year":"2018","journal-title":"Bangladesh J Sci Res"},{"issue":"9","key":"pone.0358556.ref038","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0239855","article-title":"Individual-, household-, and community-level factors associated with eight or more antenatal care contacts in Nigeria: Evidence from Demographic and Health Survey","volume":"15","author":"M Ekholuenetale","year":"2020","journal-title":"PLoS One"},{"issue":"4","key":"pone.0358556.ref039","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1111\/j.1728-4465.2002.00309.x","article-title":"Contextual influences on reproductive health service use in Uttar Pradesh, India","volume":"33","author":"R Stephenson","year":"2002","journal-title":"Stud Fam Plann"},{"issue":"4","key":"pone.0358556.ref040","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0322725","article-title":"Association of quality antenatal care and completion of eight or more antenatal care visits with skilled delivery care utilization among pregnant women in Bangladesh: A nationwide population-based study","volume":"20","author":"MO Rahman","year":"2025","journal-title":"PLoS One"},{"issue":"1","key":"pone.0358556.ref041","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s41043-016-0078-5","article-title":"Trends, determinants and inequities of 4+ ANC utilisation in Bangladesh","volume":"36","author":"A Rahman","year":"2017","journal-title":"J Health Popul Nutr"},{"issue":"1","key":"pone.0358556.ref042","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1186\/s12978-016-0201-5","article-title":"Quality of antenatal care and household wealth as determinants of institutional delivery in Pakistan: Results of a cross-sectional household survey","volume":"13","author":"S Agha","year":"2016","journal-title":"Reprod Health"},{"key":"pone.0358556.ref043","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1186\/s13104-015-1708-5","article-title":"Antenatal care and women\u2019s decision making power as determinants of institutional delivery in rural area of Western Ethiopia","volume":"8","author":"T Tekelab","year":"2015","journal-title":"BMC Res Notes"},{"key":"pone.0358556.ref044","doi-asserted-by":"crossref","first-page":"8180387","DOI":"10.1155\/2022\/8180387","article-title":"Utilization of skilled birth attendance among mothers who gave birth in the last 12 months in Kembata Tembaro Zone","volume":"2022","author":"E Mathewos Oridanigo","year":"2022","journal-title":"Adv Med"},{"issue":"4","key":"pone.0358556.ref045","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0322725","article-title":"Association of quality antenatal care and completion of eight or more antenatal care visits with skilled delivery care utilization among pregnant women in Bangladesh: A nationwide population-based study","volume":"20","author":"MO Rahman","year":"2025","journal-title":"PLoS One"},{"issue":"1","key":"pone.0358556.ref046","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1186\/s12889-019-6945-4","article-title":"Do four or more antenatal care visits increase skilled birth attendant use and institutional delivery in Bangladesh? A propensity-score matched analysis","volume":"19","author":"BL Ryan","year":"2019","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0358556.ref047","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1186\/s12889-023-16376-2","article-title":"Effects of a community-level intervention on maternal health care utilization in a resource-poor setting of Northern Ghana","volume":"23","author":"AB Kassim","year":"2023","journal-title":"BMC Public Health"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0358556","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:28:30Z","timestamp":1790011710000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0358556"}},"subtitle":[],"editor":[{"given":"Kanchan","family":"Thapa","sequence":"first","affiliation":[{"name":"Institute of Medicine","place":["NEPAL"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,21]]},"references-count":47,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0358556","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,21]]}}}