Factors associated with utilization of motorcycle ambulances by pregnant women in rural eastern Uganda: a cross-sectional study.

Rogers Ssebunya,Joseph K B Matovu

doi:10.1186/s12884-016-0808-0

Abstract

BackgroundEvidence suggests that use of motorcycle ambulances can help to improve health facility deliveries; however, few studies have explored the motivators for and barriers to their usage. We explored the factors associated with utilization of motorcycle ambulances by pregnant women in eastern Uganda.MethodsThis was a cross-sectional, mixed-methods study conducted among 391 women who delivered at four health facilities supplied with motorcycle ambulances in Mbale district, eastern Uganda, between April and May 2014. Quantitative data were collected on socio-demographic and economic characteristics, pregnancy and delivery history, and community and health facility factors associated with utilization of motorcycle ambulances using semi-structured questionnaires. Qualitative data were collected on the knowledge and attitudes towards using motorcycle ambulances by pregnant women through six focus group discussions. Using STATA v.12, we computed the characteristics of women using motorcycle ambulances and used a logistic regression model to assess the correlates of utilization of motorcycle ambulances. Qualitative data were analyzed manually using a master sheet analysis tool.ResultsOf the 391 women, 189 (48.3 %) reported that they had ever utilized motorcycle ambulances. Of these, 94.7 % were currently married or living together with a partner while 50.8 % earned less than 50,000 Uganda shillings (US $20) per month. Factors independently associated with use of motorcycle ambulances were: older age of the mother (≥35 years vs ≤24 years; adjusted Odds Ratio (aOR) = 4.3, 95 % CI: 2.03, 9.13), sharing a birth plan with the husband (aOR = 2.5, 95 % CI: 1.19, 5.26), husband participating in the decision to use the ambulance (aOR =3.22, 95 % CI: 1.92, 5.38), and having discussed the use of the ambulance with a traditional birth attendant (TBA) before using it (aOR =3.12, 95 % CI: 1.88, 5.19). Qualitative findings indicated that community members were aware of what motorcycle ambulances were meant for and appreciated their role in taking pregnant women to health facilities.ConclusionThe use of motorcycle ambulances was associated with older age of the mother, male participation in birth preparedness, and consultations with TBAs. These findings suggest a need for interventions to involve men in reproductive health as well as efforts to reach women younger than 35 years of age.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-0808-0) contains supplementary material, which is available to authorized users.

Highlights

Evidence suggests that use of motorcycle ambulances can help to improve health facility deliveries; few studies have explored the motivators for and barriers to their usage
The proportion of women who delivered at the hands of skilled personnel has increased from 59 % in 1990 to 70 % in 2013 globally, in sub-Saharan Africa, this proportion remains below 50 % [2, 3]
Our study of the factors affecting utilization of motorcycle ambulances by pregnant women in Mbale district, Uganda, found that utilization of motorcycle ambulances is associated with older age of the mother, involvement of the male partner in the discussion of whether or not to use a motorcycle ambulance, women sharing birth plans with their husbands, and women consulting traditional birth attendants before using the motorcycle ambulances

Summary

Introduction

Evidence suggests that use of motorcycle ambulances can help to improve health facility deliveries; few studies have explored the motivators for and barriers to their usage. The proportion of women who delivered at the hands of skilled personnel has increased from 59 % in 1990 to 70 % in 2013 globally, in sub-Saharan Africa, this proportion remains below 50 % [2, 3]. Studies show that many pregnant women, especially in sub-Saharan Africa, continue to deliver at the hands of traditional birth attendants or at home [4,5,6]. The consequences arising from lack of skilled birth attendance are usually fatal [8,9,10], with both maternal and neonatal mortality increasing among women delivering outside formal health care systems. Maternal mortality remains high at 438/100,000 live births [11], partly because most women don’t have access to a skilled birth attendant

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Results

Discussion

Conclusion