Abstract
IntroductionGiving birth in a health facility is associated with lower maternal mortality than giving birth at home. A recent Tanzania Demographic Health survey showed that, although more than 90% of pregnant women attended at least one antenatal clinic visit, only 50% of pregnant women delivered at a health facility. The aim of this study was to document the magnitude and predictors of institutional delivery in order to assist in setting priorities and developing appropriate intervention measures to reduce maternal mortality.MethodsWe conducted a cross-sectional study of women in Biharamulo district who delivered during the year preceding the survey. Multistage sampling was used to obtain 598 participants. A structured questionnaire was used to collect data. Bivariate and multivariate analysis was performed.Results56% of women delivered in a health facility. Factors most strongly associated with institutional delivery were past care experience (aOR=265.1, 95%CI 28.6-2466.7), advice from health care provider to deliver at a health care facility (aOR=29.2, 95%CI 2.9-291.5), decision making on health care seeking on a pregnancy (aOR=7.1, 95%CI 2.7-19.0), maternal education (aOR=6.7, 95%CI 2.3-20.0), first antenatal care visit at <16 weeks (aOR=2.4, 95%CI 1.0-5.1), stable maternal income (aOR=2.3, 95%CI (1.1-4.7), and distance to facility <5 km (aOR 2.3 (95%CI 1.3-3.9).ConclusionThe prevalence of institutional delivery in Biharamulo District remains low. To raise the prevalence, the district should implement measures to make institutional delivery the preferred option for pregnant women. These measures should include encouraging women to make early antenatal care visits and make plans with their spouses for institutional delivery, reducing costs, improving the experience for women undergoing delivering in a healthcare facility, and consider locating new facilities closer to the women who need them.
Highlights
Giving birth in a health facility is associated with lower maternal mortality than giving birth at home
Institutional delivery was frequent among mothers and fathers with secondary or more education (88% and 83%, respectively) and with regular sources of income (80% and 86%, respectively), but varied little by maternal age or marital status Women residing less than 5 km from a health facility were more likely to have an institution delivery than those who lived ≥5 km away (69% versus 42%)
Institution delivery was more common among women whose first antenatal visit was before 16 weeks gestation (75%), and among those who made more than four antenatal visits (65%)
Summary
Giving birth in a health facility is associated with lower maternal mortality than giving birth at home. Factors most strongly associated with institutional delivery were past care experience (aOR=265.1, 95%CI 28.62466.7), advice from health care provider to deliver at a health care facility (aOR=29.2, 95%CI 2.9-291.5), decision making on health care seeking on a pregnancy (aOR=7.1, 95%CI 2.7-19.0), maternal education (aOR=6.7, 95%CI 2.3-20.0), first antenatal care visit at Conclusion: The prevalence of institutional delivery in Biharamulo District remains low. Achieving good maternal health requires quality reproductive health services and a series of well-timed interventions to ensure a women's safe passage to motherhood Failure to provide these services results in hundreds of thousands of needless deaths each year. Health facility delivery among pregnant mothers can be increased through antenatal clinic (ANC) attendance by providing reproductive health education and services
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