Abstract
BACKGROUND: Delays in seeking care during pregnancy and childbirth can result in serious complications for women and a major contributor to maternal illness and death, especially in low-resource countries like Ethiopia. However, there is an inconsistency in findings of a study that has been conducted on the delay in decision to seek care. Thus, this review aimed to determine the combined prevalence of delay in decision to seek care and associated factors in Ethiopia. METHODS: A systematic review and meta-analysis were conducted on the prevalence of delay in the decision to seek care and its associated factors. Five bibliographic databases and libraries, namely, Medline/PubMed, the Cochrane Library, Science Direct, Google Scholar, and Hinari, were used. Data extraction was performed using Microsoft Excel, and after cleaning and sorting, analysis was performed using STATA 17 software. The quality of each article was assessed using the Joanna Briggs Institute critical appraisal tool for prevalence studies. The pooled rate of delays in the decision to seek care and associated factors among mothers was estimated with a random-effects model. Heterogeneity was examined using Cochrane Q statistics and the I2 test, and publication bias was assessed by funnel plots and Egger's regression test. RESULTS: A total of twelve studies were included in this review. The pooled prevalence of delays in the decision to seek care at health facilities among women in Ethiopia was 44.69% (95% CI: 37.02-52.36). Several factors were significantly associated with these delays, including having no formal education (AOR = 4.48; 95% CI: 3.30-5.60), residing in rural areas (AOR = 5.40; 95% CI: 2.30-8.50), being unemployed (AOR = 2.60; 95% CI: 1.80-3.49), husband-only decision-making (AOR = 2.80; 95% CI: 1.13-4.50), and lack of antenatal care follow-up (AOR = 2.90; 95% CI: 1.30-4.10). CONCLUSION: The high pooled prevalence of delayed decision-making in seeking care highlights the urgent need for targeted interventions. These should focus on enhancing access to healthcare services, increasing maternal education, and promoting consistent antenatal care follow-up. Addressing these areas can significantly reduce delays and lead to improve maternal and public health outcomes.