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"Not too far to walk": the influence of distance on place of delivery in a western Kenya health demographic surveillance system.

ABSTRACT: BACKGROUND: Maternal health service coverage in Kenya remains low, especially in rural areas where 63% of women deliver at home, mainly because health facilities are too far away and/or they lack transport. The objectives of the present study were to (1) determine the association between the place of delivery and the distance of a household from the nearest health facility and (2) study the demographic characteristics of households with a delivery within a demographic surveillance system (DSS). METHODS: Census sampling was conducted for 13,333 households in the Webuye health and demographic surveillance system area in 2008-2009. Information was collected on deliveries that had occurred during the previous 12 months. Digital coordinates of households and sentinel locations such as health facilities were collected. Data were analyzed using STATA version 11. The Euclidean distance from households to health facilities was calculated using WinGRASS version 6.4. Hotspot analysis was conducted in ArcGIS to detect clustering of delivery facilities. Unadjusted and adjusted odds ratios were estimated using logistic regression models. P-values less than 0.05 were considered significant. RESULTS: Of the 13,333 households in the study area, 3255 (24%) reported a birth, with 77% of deliveries being at home. The percentage of home deliveries increased from 30% to 80% of women living within 2 km from a health facility. Beyond 2 km, distance had no effect on place of delivery (OR 1.29, CI 1.06-1.57, p?=?0.011). Heads of households where women delivered at home were less likely to be employed (OR 0.598, CI 0.43-0.82, p?=?0.002), and were less likely to have secondary education (OR 0.50, CI 0.41-0.61, p?

SUBMITTER: Mwaliko E

PROVIDER: S-EPMC4036729 | biostudies-other | 2014

REPOSITORIES: biostudies-other

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"Not too far to walk": the influence of distance on place of delivery in a western Kenya health demographic surveillance system.

Mwaliko Emily E Downing Raymond R O'Meara Wendy W Chelagat Dinah D Obala Andrew A Downing Timothy T Simiyu Chrispinus C Odhiambo David D Ayuo Paul P Menya Diana D Khwa-Otsyula Barasa B

BMC health services research 20140510

<h4>Background</h4>Maternal health service coverage in Kenya remains low, especially in rural areas where 63% of women deliver at home, mainly because health facilities are too far away and/or they lack transport. The objectives of the present study were to (1) determine the association between the place of delivery and the distance of a household from the nearest health facility and (2) study the demographic characteristics of households with a delivery within a demographic surveillance system ...[more]

PMID: 24884489

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Project description:BackgroundAn estimated 358,000 maternal deaths still occur worldwide each year. The place of delivery is of great significance to the reduction of maternal mortality. Moreover, socio-economic factors, cultural traits, and local customs are associated with health-seeking behavior. This study aimed to explore determinants of association between social support and place of delivery.MethodsThis cross-sectional study was conducted from September to November 2011 at Sosiot Health Center, Kericho West District, Kenya. Participants were 303 mothers who brought their babies to the health center for immunization within their first year of life. Women underwent a structured interview using a questionnaire on demographic characteristics and their experiences of delivery including place of delivery and social support.ResultsThe proportion of deliveries at health facilities was significantly higher in unmarried than married women (93% and 78%, respectively; P?=?0.008). Unmarried women whose mothers supported them in housework and whose sisters helped them fetch water were more likely to deliver at health facilities (P?=?0.002 and 0.042, respectively) than those without this support. However, married women whose husbands supported them in farming and whose neighbors helped them fetch water were less likely to deliver at health facilities (P?=?0.003 and 0.021, respectively) than those without this support. Married women who were advised to deliver at a health facility by their mother-in-law or health staff were more likely to deliver at health facilities (P?=?0.015 and 0.022, respectively) than those who did not receive this advice. Multivariate analysis revealed that married women were more likely to deliver at health facilities if they were highly educated (odds ratio [OR]?=?2.5); had financial capability (OR?=?4.3); had medical insurance (OR?=?4.2); were primiparous (OR?=?3.5); did not have the support of sisters-in-law for fetching water (OR?=?2.2); or were advised to deliver at a health facility by family or neighbors (OR?=?2.5).ConclusionsPromotion of delivery at health facilities requires approaches that consider women's social situation, since factors influencing place of delivery differ for married and unmarried women.

Project description:BackgroundMaternal and perinatal mortality could be reduced if all women delivered in settings where skilled attendants could provide emergency obstetric care (EmOC) if complications arise. Research on determinants of skilled attendance at delivery has focussed on household and individual factors, neglecting the influence of the health service environment, in part due to a lack of suitable data. The aim of this study was to quantify the effects of distance to care and level of care on women's use of health facilities for delivery in rural Zambia, and to compare their population impact to that of other important determinants.Methods and findingsUsing a geographic information system (GIS), we linked national household data from the Zambian Demographic and Health Survey 2007 with national facility data from the Zambian Health Facility Census 2005 and calculated straight-line distances. Health facilities were classified by whether they provided comprehensive EmOC (CEmOC), basic EmOC (BEmOC), or limited or substandard services. Multivariable multilevel logistic regression analyses were performed to investigate the influence of distance to care and level of care on place of delivery (facility or home) for 3,682 rural births, controlling for a wide range of confounders. Only a third of rural Zambian births occurred at a health facility, and half of all births were to mothers living more than 25 km from a facility of BEmOC standard or better. As distance to the closest health facility doubled, the odds of facility delivery decreased by 29% (95% CI, 14%-40%). Independently, each step increase in level of care led to 26% higher odds of facility delivery (95% CI, 7%-48%). The population impact of poor geographic access to EmOC was at least of similar magnitude as that of low maternal education, household poverty, or lack of female autonomy.ConclusionsLack of geographic access to emergency obstetric care is a key factor explaining why most rural deliveries in Zambia still occur at home without skilled care. Addressing geographic and quality barriers is crucial to increase service use and to lower maternal and perinatal mortality. Linking datasets using GIS has great potential for future research and can help overcome the neglect of health system factors in research and policy. Please see later in the article for the Editors' Summary.

Dataset Information

"Not too far to walk": the influence of distance on place of delivery in a western Kenya health demographic surveillance system.

Publications

"Not too far to walk": the influence of distance on place of delivery in a western Kenya health demographic surveillance system.

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