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BMC Pregnancy and Childbirth

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01-12-2020 | Research article

Community-level factors associated with the use of facility-based delivery assistance in Uganda: a multilevel analysis

Authors: Angela E. Micah, David R. Hotchkiss

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

Abstract

Background

In low- and middle-income countries, the proportion of pregnant women who use health facilities for delivery remains low. Although delivering in a health facility with skilled health providers can make the critical difference between survival and death for both mother and child, in 2016, more than 25% of pregnant women did not deliver in a health facility in Uganda. This study examines the association of contextual factors measured at the community-level with use of facility-based delivery in Uganda, after controlling for household and individual-level factors.

Methods

Pooled household level data of 3310 observations of women who gave birth in the last five years is linked to community level data from the Uganda National Panel Survey (UNPS). A multilevel model that adequately accounted for the clustered nature of the data and the binary outcome of whether or not the woman delivered in a health facility was estimated.

Results

The study findings show a positive association at the county level between place of delivery, education and access to health services, and a negative association between place of delivery and poverty. Individuals living in communities with a high level of education amongst the household heads were 1.67 times (95% Confidence Interval: 1.07–2.61) more likely to have had a facility-based delivery compared to women living in communities where household heads did not have high levels of education. Women who lived in counties with a short travel time (less than 33 min) were 1.66 times (95% CI: 1.11–2.48) more likely to have had a facility-based delivery compared to women who lived in counties with longer travel time to any health facility. Women living in poor counties were only 0.64 times (95% CI: 0.42–0.97) as likely to have delivered in a health facility compared to pregnant women from communities with more affluent individuals.

Conclusions

The findings on household head’s education, community economic status and travel time to a health facility are useful for defining the attributes for targeting and developing relevant nation-wide community-level health promotion campaigns. However, limited evidence was found in broad support of the role of community level factors.

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Title: Community-level factors associated with the use of facility-based delivery assistance in Uganda: a multilevel analysis
Authors: Angela E. Micah
David R. Hotchkiss
Publication date: 01-12-2020
Publisher: BioMed Central
Published in: BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-020-2851-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Community-level factors associated with the use of facility-based delivery assistance in Uganda: a multilevel analysis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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