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Prevalence and predictors of giving birth in health facilities in Bugesera District, Rwanda.

Joharifard S, Rulisa S, Niyonkuru F, Weinhold A, Sayinzoga F, Wilkinson J, Ostermann J, Thielman NM - BMC Public Health (2012)

Bottom Line: Delivering a penultimate baby at a health facility (OR = 4.681 [3.204 - 6.839]), possessing health insurance (OR = 3.812 [1.795 - 8.097]), managing household finances (OR = 1.897 [1.046 - 3.439]), attending more antenatal care visits (OR = 1.567 [1.163 - 2.112]), delivering more recently (OR = 1.438 [1.120 - 1.847] annually), and living closer to a health center (OR = 0.909 [0.846 - 0.976] per km) were independently associated with facility delivery.The strongest correlates of facility-based delivery in Bugesera District include previous delivery at a health facility, possession of health insurance, greater financial autonomy, more recent interactions with the health system, and proximity to a health center.Recent structural interventions in Rwanda, including the rapid scale-up of community-financed health insurance, likely contributed to the dramatic improvement in the health facility delivery rate observed in our study.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Division of General Surgery, University of British Columbia, Vancouver, BC, Canada

ABSTRACT

Background: The proportion of births attended by skilled health personnel is one of two indicators used to measure progress towards Millennium Development Goal 5, which aims for a 75% reduction in global maternal mortality ratios by 2015. Rwanda has one of the highest maternal mortality ratios in the world, estimated between 249-584 maternal deaths per 100,000 live births. The objectives of this study were to quantify secular trends in health facility delivery and to identify factors that affect the uptake of intrapartum healthcare services among women living in rural villages in Bugesera District, Eastern Province, Rwanda.

Methods: Using census data and probability proportional to size cluster sampling methodology, 30 villages were selected for community-based, cross-sectional surveys of women aged 18-50 who had given birth in the previous three years. Complete obstetric histories and detailed demographic data were elicited from respondents using iPad technology. Geospatial coordinates were used to calculate the path distances between each village and its designated health center and district hospital. Bivariate and multivariate logistic regressions were used to identify factors associated with delivery in health facilities.

Results: Analysis of 3106 lifetime deliveries from 859 respondents shows a sharp increase in the percentage of health facility deliveries in recent years. Delivering a penultimate baby at a health facility (OR = 4.681 [3.204 - 6.839]), possessing health insurance (OR = 3.812 [1.795 - 8.097]), managing household finances (OR = 1.897 [1.046 - 3.439]), attending more antenatal care visits (OR = 1.567 [1.163 - 2.112]), delivering more recently (OR = 1.438 [1.120 - 1.847] annually), and living closer to a health center (OR = 0.909 [0.846 - 0.976] per km) were independently associated with facility delivery.

Conclusions: The strongest correlates of facility-based delivery in Bugesera District include previous delivery at a health facility, possession of health insurance, greater financial autonomy, more recent interactions with the health system, and proximity to a health center. Recent structural interventions in Rwanda, including the rapid scale-up of community-financed health insurance, likely contributed to the dramatic improvement in the health facility delivery rate observed in our study.

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Figure 2: Sampling process.

Mentions: A total of 959 women meeting inclusion criteria were interviewed, of which 895 were retained in the final database (see Figure2). The ages of the respondents ranged from 18–49 with a mean age of 29.4 years (SD 6.3). Over half (54.4%) of the respondents were married and an additional 31.2% were living with a man. Nearly 20% had never attended school, while the mean number of years of schooling among those who attended was 5.1 (SD 2.3). The primary occupation of the sampled women was subsistence agriculture, accounting for 90.1% of respondents. More than 86% of respondents were subscribers of a national community-funded health insurance program known as Mutuelle de Santé, while 10.9% did not have any form of health insurance. The majority of respondents (57.4%) had given birth between 2–5 times, with a mean parity of 3.5 (SD 2.3) (see Table1).


Prevalence and predictors of giving birth in health facilities in Bugesera District, Rwanda.

Joharifard S, Rulisa S, Niyonkuru F, Weinhold A, Sayinzoga F, Wilkinson J, Ostermann J, Thielman NM - BMC Public Health (2012)

Sampling process.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3539866&req=5

Figure 2: Sampling process.
Mentions: A total of 959 women meeting inclusion criteria were interviewed, of which 895 were retained in the final database (see Figure2). The ages of the respondents ranged from 18–49 with a mean age of 29.4 years (SD 6.3). Over half (54.4%) of the respondents were married and an additional 31.2% were living with a man. Nearly 20% had never attended school, while the mean number of years of schooling among those who attended was 5.1 (SD 2.3). The primary occupation of the sampled women was subsistence agriculture, accounting for 90.1% of respondents. More than 86% of respondents were subscribers of a national community-funded health insurance program known as Mutuelle de Santé, while 10.9% did not have any form of health insurance. The majority of respondents (57.4%) had given birth between 2–5 times, with a mean parity of 3.5 (SD 2.3) (see Table1).

Bottom Line: Delivering a penultimate baby at a health facility (OR = 4.681 [3.204 - 6.839]), possessing health insurance (OR = 3.812 [1.795 - 8.097]), managing household finances (OR = 1.897 [1.046 - 3.439]), attending more antenatal care visits (OR = 1.567 [1.163 - 2.112]), delivering more recently (OR = 1.438 [1.120 - 1.847] annually), and living closer to a health center (OR = 0.909 [0.846 - 0.976] per km) were independently associated with facility delivery.The strongest correlates of facility-based delivery in Bugesera District include previous delivery at a health facility, possession of health insurance, greater financial autonomy, more recent interactions with the health system, and proximity to a health center.Recent structural interventions in Rwanda, including the rapid scale-up of community-financed health insurance, likely contributed to the dramatic improvement in the health facility delivery rate observed in our study.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Division of General Surgery, University of British Columbia, Vancouver, BC, Canada

ABSTRACT

Background: The proportion of births attended by skilled health personnel is one of two indicators used to measure progress towards Millennium Development Goal 5, which aims for a 75% reduction in global maternal mortality ratios by 2015. Rwanda has one of the highest maternal mortality ratios in the world, estimated between 249-584 maternal deaths per 100,000 live births. The objectives of this study were to quantify secular trends in health facility delivery and to identify factors that affect the uptake of intrapartum healthcare services among women living in rural villages in Bugesera District, Eastern Province, Rwanda.

Methods: Using census data and probability proportional to size cluster sampling methodology, 30 villages were selected for community-based, cross-sectional surveys of women aged 18-50 who had given birth in the previous three years. Complete obstetric histories and detailed demographic data were elicited from respondents using iPad technology. Geospatial coordinates were used to calculate the path distances between each village and its designated health center and district hospital. Bivariate and multivariate logistic regressions were used to identify factors associated with delivery in health facilities.

Results: Analysis of 3106 lifetime deliveries from 859 respondents shows a sharp increase in the percentage of health facility deliveries in recent years. Delivering a penultimate baby at a health facility (OR = 4.681 [3.204 - 6.839]), possessing health insurance (OR = 3.812 [1.795 - 8.097]), managing household finances (OR = 1.897 [1.046 - 3.439]), attending more antenatal care visits (OR = 1.567 [1.163 - 2.112]), delivering more recently (OR = 1.438 [1.120 - 1.847] annually), and living closer to a health center (OR = 0.909 [0.846 - 0.976] per km) were independently associated with facility delivery.

Conclusions: The strongest correlates of facility-based delivery in Bugesera District include previous delivery at a health facility, possession of health insurance, greater financial autonomy, more recent interactions with the health system, and proximity to a health center. Recent structural interventions in Rwanda, including the rapid scale-up of community-financed health insurance, likely contributed to the dramatic improvement in the health facility delivery rate observed in our study.

Show MeSH
Related in: MedlinePlus