Predictors for health facility delivery in Busia district of Uganda: a cross sectional study

BMC Pregnancy and Childbirth

Fred Nuwaha²  George Bwire Oundo¹  David Mukanga²  Agnes Anyait² 

[1]Busia district, Directorate of Health Services, P.O. Box 124, Busia, Uganda

[2]Makerere University School of Public Health, P.O Box 7072, Kampala, Uganda

关键词: Sub-Saharan Africa;    Birth plan;    Male involvement;    Home deliveries;   

Others  :  1151890
DOI  :  10.1186/1471-2393-12-132

 received in 2012-08-10, accepted in 2012-11-16,  发布年份 2012

【 摘 要 】

Background

Among the factors contributing to the high maternal morbidity and mortality in Uganda is the high proportion of pregnant women who do not deliver under supervision in health facilities. This study aimed to identify the independent predictors of health facility delivery in Busia a rural district in Uganda with a view of suggesting measures for remedial action.

Methods

In a cross sectional survey, 500 women who had a delivery in the past two years (from November 16 2005 to November 15 2007) were interviewed regarding place of delivery, demographic characteristics, reproductive history, attendance for antenatal care, accessibility of health services, preferred delivery positions, preference for disposal of placenta and mother’s autonomy in decision making. In addition the household socio economic status was assessed. The independent predictors of health facility delivery were identified by comparing women who delivered in health facilities to those who did not, using bivariate and binary logistic regression analysis.

Results

Eight independent predictors that favoured delivery in a health facility include: being of high socio-economic status (adjusted odds ratio [AOR] 2.8 95% Confidence interval [95% CI]1.2–6.3), previous difficult delivery (AOR 4.2, 95% CI 3.0–8.0), parity less than four (AOR 2.9, 95% CI 1.6–5.6), preference of supine position for second stage of labour (AOR 5.9, 95% CI 3.5–11.1) preferring health workers to dispose the placenta (AOR 12.1, 95% CI 4.3–34.1), not having difficulty with transport (AOR 2.0, 95% CI 1.2–3.5), being autonomous in decision to attend antenatal care (AOR 1.9, 95% CI 1.1–3.4) and depending on other people (e.g. spouse) in making a decision of where to deliver from (AOR 2.4, 95% CI 1.4–4.6). A model with these 8 variables had an overall correct classification of 81.4% (chi square = 230.3, P < 0.001).

Conclusions

These data suggest that in order to increase health facility deliveries there is need for reaching women of low social economic status and of higher parity with suitable interventions aimed at reducing barriers that make women less likely to deliver in health units such as ensuring availability of transport and involving spouses in the birth plan.

【 授权许可】

   
2012 Anyait et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]WHO, UNICEF, UNFPA: Maternal mortality in 2000: estimates developed by WHO, UNICEF and UNFPA. Geneva: UNFPA; 2004.
• [2]Villar J, Bergsjo P: Scientific basis for the content of routine antenatal care. I. Philosophy, recent studies, and power to eliminate or alleviate adverse maternal outcomes. Acta Obstet Gynecol Scand 1997, 76:1-14.
• [3]Bergsjo P, Villar J: Scientific basis for the content of routine antenatal care. II. Power to eliminate or alleviate adverse newborn outcomes; some special conditions and examinations. Acta Obstet Gynecol Scand 1997, 76:15-25.
• [4]Villar J, Ba’aqeel H, Piaggio G, Lumbiganon P, Miguel Belizán J, Farnot U, Al-Mazrou Y, Carroli G, Pinol A, Donner A, Langer A, Nigenda G, Mugford M, Fox-Rushby J, Hutton G, Bergsjø P, Bakketeig L, Berendes H, Garcia J, WHO Antenatal Care Trial Research Group: WHO antenatal care randomized trial for the evaluation of a new model of routine antenatal care. Lancet 2001, 357:1551-1564.
• [5]United Nations: The Millennium Development Goals Report 2005. New York: United Nations; 2006.
• [6]Koblinsky MA, Campbell O, Heichelheim J: Organizing delivery care: what works for safe motherhood? Bull World Health Organ 1999, 77:399-406.
• [7]De Brouwere V, Tonglet R, Van Lerberghe W: Strategies for reducing maternal mortality in developing countries: what can we learn from the history of the industrialized West? Trop Med Int Health 1998, 3:771-782.
• [8]WHO, UNICEF: Antenatal care in developing countries. Promises, achievements and missed opportunities. An analysis of trends, levels and differentials, 1990–2001. Geneva: WHO; 2003.
• [9]Uganda Bureau of Statistics (UBOS) and Macro International Inc: Uganda Demographic and Health Survey 2006. Calverton: UBOS and Macro International Inc; 2007.
• [10]Obermeyer CM: Culture, maternal health care, and women’s status: a comparison of Morocco and Tunisia. Stud Fam Plan 1993, 24:354-365.
• [11]Bhatia J, Cleland J: Determinants of maternal care in a region of South India. Health Trans Rev 1995, 5:127-142.
• [12]Basu AM: Culture influences on Health Care use: two regional groups in India. Stud Fam Plan 1990, 21:275-288.
• [13]Magadi M, Madise N, Diamond I: Factors associated with unfavourable birth outcomes in Kenya. J Biosoc Sci 2001, 33:199-225.
• [14]Anguzu J, Oryema-Lalobo M, Oundo GB, Nuwaha F: Community perception of intestinal schistosomiasis in Busia District of Uganda. East Afr Med J 2007, 84:56-66.
• [15]Rahman MH, Mosley WH, Ahmed S, Akhter HH: Does service delivery accessibility reduce socio-economic differentials in maternity care seeking? Evidence from rural Bangladesh. J Biosoc Sci 2008, 40:19-33.
• [16]Amooti-Kaguna B, Nuwaha F: Factors influencing choice of delivery sites in Rakai District of Uganda. Soc Sci Med 2000, 50:203-213.
• [17]Bantebya-Kyomuhendo G: Low use of rural maternity services in Uganda: impact of women’s status, traditional beliefs and limited resources. Rep Health Matter 2003, 11:16-26.
• [18]Kasolo J, Ampaire C: Knowledge, Attitudes and Practices of Women and Men towards Safe Motherhood in Rural Settings. Kampala: Uganda DISH II project; 2000.
• [19]Allahbadia GN, Vaidya PR: Why deliver in the supine position? Aust N Z J Obstet Gynaecol 1992, 32:104-106.
• [20]Méndez-Bauer C, Arroyo J, García Ramos C, Menéndez A, Lavilla M, Izquierdo F, Villa Elízaga I, Zamarriego J: Effects of standing position on spontaneous uterine contractility and other aspects of labor. J Perinat Med 1975, 3:89-100.
• [21]Williams RM, Thom MH, Studd JW: A study of the benefits and acceptability of ambulation in spontaneous labour. Br J Obstet Gynaecol 1980, 87:122-126.
• [22]Roberts JE, Mendez-Bauer C, Blackwell J, Carpenter ME, Marchese T: Effects of lateral recumbency and sitting on the first stage of labor. J Reprod Med 1984, 29:477-481.
• [23]Diaz AG, Schwarcz R, Fescina R, Caldeyro-Barcia R: Vertical position during the first stage of the course of labor, and neonatal outcome. Eur J Obstet Gynecol Reprod Biol 1980, 11:1-7.
• [24]Amin R, Becker S, Bayes A: NGO-promoted micro credit programs and women’s empowerment in rural Bangladesh: quantitative and qualitative evidence. J Dev Areas 1998, 32:221-236.
• [25]Ahmed SM, Adams AM, Chowdhury M, Bhuiya A: Changing health-seeking behavior in Matlab, Bangladesh: do development interventions matter? Health Policy Plan 2003, 18:306-315.
• [26]Sternberg R, Hubley J: Evaluating men’s involvement as a strategy in sexual and reproductive health promotion. Health Promot Int 2004, 19:389-396.
• [27]PetePopoola D: Involving men in reproductive health advocacy in the United Republic of Tanzania. Health Promot Educ 1999, 6:20-23.
• [28]Mullany BC, Becker S, Hindin M: The impact of including husbands in antenatal health education services on maternal health practices in urban Nepal: results from a randomized controlled trial. Health Educ Res 2007, 22:166-176.
• [29]Bolaji FM, Rutenberg N: Expanding Men’s Participation in Reproductive Health in Kenya. Nairobi: African Population Policy Research Center; 1999.
• [30]de Vries H, Dijkstra M, Kuhlman P: Self-Efficacy: the third factor besides attitude and subjective norm as predictor of behaviour intentions. Health Educ Res 1988, 3:273-282.
• [31]Ajzen I: The theory of planned behaviour. Organ Behav Hum Decis Process 1991, 50:179-211.
• [32]Stewart P, Calder AA: Posture in labour: patients’ choice and its effect on performance. Br J Obstet Gynaecol 1984, 91:1091-1095.