Abstract
BackgroundAssistance during delivery by a skilled attendant is recommended as a means to reduce child and maternal mortality. Globally, higher levels of maternal education have been associated with better health behaviours at delivery. However, given that heads of households tend to be the decision makers regarding accessing healthcare, some educated mothers may find themselves prevented from accessing healthcare at the point of delivery.MethodsWe examined the association between head of household education level and health seeking behaviours at delivery across a sample of 392 households. Chi-squared analysis and odds ratios were calculated to measure the strength of the relationship between no, some primary, or some secondary or higher education attained by the head of household and the presence or absence of a skilled birth attendant at that child’s birth, and whether the birth took place at a health facility.ResultsHeads of household (n = 392) were predominantly male (93.4% [(90.9%, 95.8%), a = 0.05]). We found a significant difference in skilled birth attendance between heads of households with some primary education and heads of household with some secondary education or higher (χ2 (1) = 6.231, p <0.05) whereby those with secondary or higher education were significantly more likely to seek a skilled birth attendant (OR = 1.5,[1.1,2.1]). The difference in health centre delivery between heads of household with a primary education and heads of household with a secondary or higher education was also significant (χ2 (1) = 7.519, p <0.05). Those with secondary or higher education were significantly more likely to deliver in a health facility (OR = 1.6,[1.2,2.1]).ConclusionsThe results of our analysis, which identified the vast majority of heads of households as men, suggests that education, or rather limited or a lack of education for the head of household, may be a barrier to women’s use of health care in Uganda and therefore reinforces the need to increase educational access among male heads of households. Improving the rates of health centre deliveries and utilization of services provided by skilled health workers might lie, in part, in increasing overall education levels of heads of households, specifically the education of male heads of households.
Highlights
Assistance during delivery by a skilled attendant is recommended as a means to reduce child and maternal mortality
Of the Head of household (HOH) who responded to the education level question (n = 373), 5.6% had no form of education ([3.3%, 8.0%]), 58.7% had achieved some level of primary education [53.7%, 63.7%]), and 35.7% had completed at least some secondary level education or higher [30.8%, 40.5%])
Adjustment via multinomial logistic regression was considered for age and gender of the HOH as both were associated with education level attained, it had no effect on the outcome as neither were associated with delivery practices and reduced the reliability of the model
Summary
Assistance during delivery by a skilled attendant is recommended as a means to reduce child and maternal mortality. The last two decades have seen an increase in the rate of births assisted by SBAs worldwide, except in subSaharan Africa, where barriers still prevent women from accessing SBAs [10] Such barriers include: lack of transportation, distance from the health centre, cost of travel and health services, perceived low-quality of care in facilities, unavailability of emergency obstetric care at health centres, and cultural barriers including women’s inability to travel alone and their adherence to traditional practices [2,11,12,13,14,15]. In Uganda’s Eastern region, 39.6% of births were accompanied by an unskilled assistant such as a traditional birth attendant (TBA), a relative or a friend, and 7.7% of births received no assistance at all [17]
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