Factors associated with health facility childbirth in districts of Kenya, Tanzania and Zambia: a population based survey

BMC Pregnancy and Childbirth

Knut Fylkesnes²  Elizabeth Echoka⁶  Charles Michelo¹  Bjørg Evjen-Olsen⁵  Jens Byskov³  Gunnar Kvåle²  Torvid Kiserud⁴  Selia Ng’anjo Phiri² 

[1]Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia

[2]Centre for International Health, Department of Global Health and Primary Care, University of Bergen, Bergen, Norway

[3]Centre for Health Research and Development, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

[4]Department of Clinical Science, University of Bergen, Bergen, Norway

[5]Department of Obstetrics and Gynaecology, Sørlandet Hospital, Flekkefjord, Norway

[6]Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya

关键词: Zambia;    Tanzania;    Kenya;    Africa;    Inequity;    Socioeconomic position;    Home deliveries;    Health facility childbirth;   

Others  :  840676
DOI  :  10.1186/1471-2393-14-219

 received in 2013-10-09, accepted in 2014-06-27,  发布年份 2014

【 摘 要 】

Background

Maternal mortality continues to be a heavy burden in low and middle income countries where half of all deliveries take place in homes without skilled attendance. The study aimed to investigate the underlying and proximate determinants of health facility childbirth in rural and urban areas of three districts in Kenya, Tanzania and Zambia.

Methods

A population-based survey was conducted in 2007 as part of the ‘REsponse to ACcountable priority setting for Trust in health systems’ (REACT) project. Stratified random cluster sampling was used and the data included information on place of delivery and factors that might influence health care seeking behaviour. A total of 1800 women who had childbirth in the previous five years were analysed. The distal and proximate conceptual framework for analysing determinants of maternal mortality was modified for studying factors associated with place of delivery. Socioeconomic position was measured by employing a construct of educational attainment and wealth index. All analyses were stratified by district and urban–rural residence.

Results

There were substantial inter-district differences in proportion of health facility childbirth. Facility childbirth was 15, 70 and 37% in the rural areas of Malindi, Mbarali and Kapiri Mposhi respectively, and 57, 75 and 77% in the urban areas of the districts respectively. However, striking socio-economic inequities were revealed regardless of district. Furthermore, there were indications that repeated exposure to ANC services and HIV related counselling and testing were positively associated with health facility deliveries. Perceived distance was negatively associated with facility childbirth in rural areas of Malindi and urban areas of Kapiri Mposhi.

Conclusion

Strong socio-economic inequities in the likelihood of facility childbirths were revealed in all the districts added to geographic inequities in two of the three districts. This strongly suggests an urgent need to strengthen services targeting disadvantaged and remote populations. The finding of a positive association between HIV counselling/testing and odds in favor of giving birth at a health facility suggests potential positive effects can be achieved by strengthening integrated approaches in maternal health service delivery.

【 授权许可】

   
2014 Ng’anjo Phiri et al.; licensee BioMed Central Ltd.

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