Abstract
BackgroundHealth facility deliveries are generally associated with improved maternal and child health outcomes. However, in Uganda, little is known about factors that influence use of health facilities for delivery especially in rural areas. In this study, we assessed the factors associated with health facility deliveries among mothers living within the catchment areas of major health facilities in Rukungiri and Kanungu districts, Uganda.MethodsCross-sectional data were collected from 894 randomly-sampled mothers within the catchment of two private hospitals in Rukungiri and Kanungu districts. Data were collected on the place of delivery for the most recent child, mothers’ sociodemographic and economic characteristics, and health facility water, sanitation and hygiene (WASH) status. Modified Poisson regression was used to estimate prevalence ratios (PRs) for the determinants of health facility deliveries as well as factors associated with private versus public utilization of health facilities for childbirth.ResultsThe majority of mothers (90.2%, 806/894) delivered in health facilities. Non-facility deliveries were attributed to faster progression of labour (77.3%, 68/88), lack of transport (31.8%, 28/88), and high cost of hospital delivery (12.5%, 11/88). Being a business-woman [APR = 1.06, 95% CI (1.01–1.11)] and belonging to the highest wealth quintile [APR = 1.09, 95% CI (1.02–1.17)] favoured facility delivery while a higher parity of 3–4 [APR = 0.93, 95% CI (0.88–0.99)] was inversely associated with health facility delivery as compared to parity of 1–2. Factors associated with delivery in a private facility compared to a public facility included availability of highly skilled health workers [APR = 1.15, 95% CI (1.05–1.26)], perceived higher quality of WASH services [APR = 1.11, 95% CI (1.04–1.17)], cost of the delivery [APR = 0.85, 95% CI (0.78–0.92)], and availability of caesarean services [APR = 1.13, 95% CI (1.08–1.19)].ConclusionHealth facility delivery service utilization was high, and associated with engaging in business, belonging to wealthiest quintile and having higher parity. Factors associated with delivery in private facilities included health facility WASH status, cost of services, and availability of skilled workforce and caesarean services.
Highlights
Health facility deliveries are generally associated with improved maternal and child health outcomes
Factors associated with delivery in private facilities included health facility WASH status, cost of services, and availability of skilled workforce and caesarean services
Recognizing the paucity of information on the process and determinants of choice on childbirth location in hard to reach areas such as rural Western Uganda, this study aimed to explore the factors associated with health facility births, and draw comparisons between private and public health facilities, in order to inform the design of better approaches to increase childbirth in health facilities
Summary
Health facility deliveries are generally associated with improved maternal and child health outcomes. It has been widely acknowledged that hospital deliveries provide an effective opportunity for minimizing maternal and neonatal deaths [6,7,8], a significant fraction of mothers in low-income countries continues to deliver without the assistance of skilled health workers [9,10,11]. In these countries, most pregnant women deliver under the care of either their family members, traditional birth attendants, or no one at all [12]. Efforts to reduce maternal and neonatal mortality include initiatives to increase the proportion of mothers delivering babies in health facilities, attended to by skilled health workers [13]
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