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

Joharifard, Shahrzad

Rulisa, Stephen

Niyonkuru, Francine

Weinhold, Andrew

Sayinzoga, Felix

Wilkinson, Jeffrey

Ostermann, Jan

Thielman, Nathan M

England

2013-01-16T18:16:06Z

2012-12-05

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.

http://www.ncbi.nlm.nih.gov/pubmed/23217157

1471-2458-12-1049

1471-2458

https://hdl.handle.net/10161/6101

eng

Springer Science and Business Media LLC

BMC Public Health

10.1186/1471-2458-12-1049

BMC Public Health

Adolescent

Adult

Cluster Analysis

Cross-Sectional Studies

Delivery, Obstetric

Female

Health Promotion

Health Services Accessibility

Home Childbirth

Humans

Maternal Health Services

Maternal Mortality

Middle Aged

Prevalence

Rural Population

Rwanda

Young Adult

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

Journal article

Thielman, Nathan M|0000-0001-8152-2879

1

12

http://www.ncbi.nlm.nih.gov/pubmed/23217157

1049

Clinical Science Departments

Duke

Faculty

Global Health Institute

Institutes and Provost's Academic Units

Medicine

Medicine, Infectious Diseases

Pathology

School of Medicine

University Institutes and Centers

Published online

12