Factors That Predict Demand For Perinatal Care Among Egyptian Women: A Multivariate Logistic Regression Analysis!

Abstract

Background: Maternal mortality is high in Egypt with the majority of deaths occurring during or immediately after childbirth. These deaths could be avoided, if childbirth is undertaken in medical institutions or supervised by qualified medical staff. Although maternal services enjoy geographic availability all over Egypt, improved utilization of these services could be a key to reduction of maternal mortality. This study aimed at identifying factors that determine utilization of perinatal services among pregnant women in Egypt. Methodology: We analyzed data collected by Egypt's Demographic and Health Survey 2000, which included a probability sample of 8,999 women aged 15 to 49, who has been married at least once irrespective of their current marital status. The sample was representative at national, regional and governorate levels. Three dependent (outcome) variables were selected to reflect quality of perinatal care that is institutional delivery; attendance of childbirth by qualified medical staff and having a postnatal check up within 24 hours from delivery. The independent variables included 19 factors reflecting the demographic, socioeconomic and health characteristics of the pregnant woman and her family. The association between outcome and independent variables was examined through a multivariate logistic regression model. Results: Though perinatal services are available in Egypt, they are underutilized. The analysis showed that 51% of child births were in medical institution and 64% were attended by a medical professional. Only 20% of women had a postnatal checkup within 24 hours after delivery. The statistical analysis showed that five factors were significantly associated with all three outcome variables. Significantly higher rates of institutional delivery, birth attendance and postnatal care were shown among women who utilized antenatal care (OR 3.2, 2.9 & 2.1; respectively, p<0.01), resided in urban areas (OR 2.4, 2.7 & 1.2; respectively, p<0.01), can read and write (OR 1.5, 1.8 & 1.3; respectively, p<0.01), had near birth problems (OR 1.6, 1.4 & 2.0; respectively, p<0.01) and were current users of modern contraception (OR 1.3, 1.3 & 1.2; respectively, p<0.01). Age at first birth and having a refrigerator appeared to be associated with institutional delivery (OR 1.4, 1.3 p<0.01, respectively) and birth attendance (OR 1.4 for both factors, p<0.01) but not with postnatal care. Maternal occupation was significantly associated with birth attendance (OR 1.3, p<0.05) and postnatal care (OR 1.3, p<0.05) but not with institutional delivery.Conclusions: Improving access to services should be coupled with fostering demand for institutional delivery and birth attendance. Addressing socioeconomic barriers to care should be addressed by public health policy in Egypt. Further, the study indicates that better utilization of perinatal care was associated with utilization of antenatal care and modern contraception. This indicates that good care seeking and utilization patterns is distal factors such as socioeconomic status and educational background.