A qualitative study on barriers to utilisation of institutional delivery services in Moroto and Napak districts, Uganda: implications for programming.

Calistus Wilunda,Giovanni Dall’Oglio,Risa Takahashi,Peter Lochoro,Rose Miligan Lochiam,Fabio Manenti,Andrea Atzori,Giovanni Putoto,Koyejo Oyerinde,Gianluca Quaglio,Aline Mukundwa

doi:10.1186/1471-2393-14-259

Calistus Wilunda, Giovanni Dall’Oglio + Show 9 more

Open Access

https://doi.org/10.1186/1471-2393-14-259

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Abstract

BackgroundSkilled attendance at delivery is critical in prevention of maternal deaths. However, many women in low- and middle-income countries still deliver without skilled assistance. This study was carried out to identify perceived barriers to utilisation of institutional delivery in two districts in Karamoja, Uganda.MethodsData were collected through participatory rural appraisal (PRA) with 887 participants (459 women and 428 men) in 20 villages in Moroto and Napak districts. Data were analysed using deductive content analysis. Notes taken during PRA session were edited, triangulated and coded according to recurring issues. Additionally, participants used matrix ranking to express their perceived relative significance of the barriers identified.ResultsThe main barriers to utilisation of maternal health services were perceived to be: insecurity, poverty, socio-cultural factors, long distances to health facilities, lack of food at home and at health facilities, lack of supplies, drugs and basic infrastructure at health facilities, poor quality of care at health facilities, lack of participation in planning for health services and the ready availability of traditional birth attendants (TBAs). Factors related to economic and physical inaccessibility and lack of infrastructure, drugs and supplies at health facilities were highly ranked barriers to utilisation of institutional delivery.ConclusionA comprehensive approach to increasing the utilisation of maternal health care services in Karamoja is needed. This should tackle both demand and supply side barriers using a multi-sectorial approach since the main barriers are outside the scope of the health sector. TBAs are still active in Karamoja and their role and influence on maternal health in this region cannot be ignored. A model for collaboration between skilled health workers and TBAs in order to increase institutional deliveries is needed.

Highlights

Skilled attendance at delivery is critical in prevention of maternal deaths
The practical factors influencing one behaviour are often different to those influencing another behaviour and the most effective interventions will be those directed at changing specific behaviours [10,16]
This study revealed a range of perceived barriers towards utilisation of institutional delivery services in Moroto and Napak districts

Summary

Introduction

Skilled attendance at delivery is critical in prevention of maternal deaths. Half of the world’s maternal, new-born, and child deaths occur in Sub-Saharan Africa, yet this geographic area has only 11% of the world’s population [3,4]. While most countries have made some progress with some of the MDGs, the Determinants of utilisation of maternal care services have been widely investigated both qualitatively and quantitatively in different settings [10,13,14]. The practical factors influencing one behaviour are often different to those influencing another behaviour and the most effective interventions will be those directed at changing specific behaviours [10,16]. Interventions for the reduction of perinatal and maternal mortality tend to focus on the skilled birth attendants and health facilities

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