AUTHOR=Raru Temam Beshir , Ayana Galana Mamo , Yuya Mohammed , Merga Bedasa Taye , Kure Mohammed Abdurke , Negash Belay , Birhanu Abdi , Alemu Addisu , Dessie Yadeta , Dheresa Merga TITLE=Magnitude, Trends, and Determinants of Institutional Delivery Among Reproductive Age Women in Kersa Health and Demographic Surveillance System Site, Eastern Ethiopia: A Multilevel Analysis JOURNAL=Frontiers in Global Women's Health VOLUME=Volume 3 - 2022 YEAR=2022 URL=https://www.frontiersin.org/journals/global-womens-health/articles/10.3389/fgwh.2022.821858 DOI=10.3389/fgwh.2022.821858 ISSN=2673-5059 ABSTRACT=Introduction: Institutional delivery service utilization is a critical and proven intervention for reducing maternal and neonatal mortality, as well as, improving maternal health and wellbeing by ensuring safe delivery and reducing problems occurring during childbirth. Almost all previous researchers were focused on the prevalence report and most of them were based on small sample sizes. Therefore, this study aimed to assess the magnitude, trends, and determinants of institutional delivery using surveillance data from the Kersa Health and Demographic Surveillance System (HDSS), in Eastern Ethiopia from 2015-2020. Methods: The study was conducted among women of reproductive age (15-49years) selected from Kersa HDSS site, Eastern Ethiopia for the duration of 2015 to 2020. Data were extracted from the Kersa HDSS database system. After coding and recoding, the data was exported to R software for further analysis. A chi-squared test was used for trends to examine the significance of the change. A multilevel logistic regression model was fitted to identify determinates of institutional delivery. An adjusted odds ratio with a 95% confidence interval (CI) was used to measure the strength of the associations. Results: A total of 20,033 reproductive age women were employed for analysis. The magnitude of institutional delivery was 36.51% with 95%CI (35.15-37.89). The institutional delivery has shown a decreasing trend over the six years’ and there is statistical significance for the declining. Semi-urban resident [AOR = 0.013, 95%CI: 0.01-0.016], rural resident [AOR = 0.09, 95%CI: 0.07-0.12], unable to read and write [AOR = 0.70, 95%CI: 0.65-0.76], and no antenatal care [AOR = 0.47, 95%CI: 0.44-0.51] were significantly associated with institutional delivery. Conclusion: The magnitude of institutional delivery was relatively low and has shown a decreasing trend. Community-based interventions should be strengthened to reverse the decreasing trend of institutional delivery. Targeted information education and communication should be provided to uneducated mothers and attention should be given to rural residents.