A structural equation analysis on the relationship between maternal health services utilization and newborn health outcomes: a cross-sectional study in Eastern Uganda

BMC Pregnancy and Childbirth

Research Article

Robert Wamala¹  Leonard K. Atuhaire¹  Elizabeth Ekirapa-Kiracho²  Suzanne N. Kiwanuka²  Rornald Muhumuza Kananura³  Moses Tetui⁴  Peter Waiswa⁵ 

[1] Department of Planning and Applied Statistics, Makerere University School of Statistics and Planning, Kampala, Uganda;Makerere University School of Public Health (MakSPH), Makerere University College of Health Sciences, Kampala, Uganda;Makerere University School of Public Health (MakSPH), Makerere University College of Health Sciences, Kampala, Uganda;Department of Planning and Applied Statistics, Makerere University School of Statistics and Planning, Kampala, Uganda;Maternal and Newborn Centre of Excellence, Makerere University School of Public Health, Kampala, Uganda;Makerere University School of Public Health (MakSPH), Makerere University College of Health Sciences, Kampala, Uganda;Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden;Makerere University School of Public Health (MakSPH), Makerere University College of Health Sciences, Kampala, Uganda;Global Health Division, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden;Maternal and Newborn Centre of Excellence, Makerere University School of Public Health, Kampala, Uganda;

关键词: Interrelationship;    Structural equation modeling;    Maternal health utilization;    Newborn outcomes;   

DOI  :  10.1186/s12884-017-1289-5

 received in 2016-09-22, accepted in 2017-03-23,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundNeonatal and maternal health services have a bearing on neonatal mortality. Direct and indirect factors affecting neonatal health outcomes therefore require understanding to enable well-targeted interventions. This study, therefore, assessed the interrelationship between newborn health outcomes and maternal service utilization factors.MethodsWe investigated maternal health utilization factors using health facility delivery and at least four Antenatal Care (ANC) visits; and newborn health outcomes using newborn death and low birth weight (LBW). We used data from a household cross-sectional survey that was conducted in 2015 in Kamuli, Pallisa and Kibuku districts. We interviewed 1946 women who had delivered in the last 12 months. The four interrelated (Endogenous) outcomes were ANC attendance, health facility delivery, newborn death, and LBW. We performed analysis using a structural equation modeling technique.ResultsA history of newborn death (aOR = 12.64, 95% CI 5.31–30.10) and birth of a LBW baby (aOR = 3.51, 95% CI 1.48–8.37) were directly related to increased odds of newborn death. Factors that reduced the odds of LBW as a mediating factor for newborn death were ANC fourth time attendance (aOR = 0.62, 95% CI 0.45–0.85), having post-primary level education (aOR = 0.68, 95% CI 0.46–0.98) compared to none and being gravida three (aOR = 0.49, 95% CI 0.26–0.94) compared to being gravida one. Mother’s age group, 20–24 (aOR = 0.24, 95% CI 0.08–0.75) and 25–29 years (aOR = 0.20, 95% CI 0.05–0.86) compared to 15–19 years was also associated with reduced odds of LBW. Additionally, ANC visits during the first trimester (aOR = 2.04, 95% CI 1.79–2.34), and village health teams (VHTs) visits while pregnant (aOR = 1.14, 95% CI 1.01–1.30) were associated with increased odds of at least four ANC visits, which is a mediating factor for health facility delivery, LBW and newborn death. Surprisingly, newborn death was not significantly different between health facility and community deliveries.ConclusionsAttending ANC at least four times was a mediating factor for reduced newborn death and low birth weight. Interventions in maternal health and newborn health should focus on factors that increase ANC fourth time attendance and those that reduce LBW especially in resource-limited settings. Targeting women with high-risk pregnancies is also crucial for reducing newborn deaths.

【 授权许可】

CC BY   
© The Author(s). 2017