Factors associated with health facility delivery in West and Central Africa: A multilevel analysis of seven countries

High risk fertility behaviour and health facility delivery in West Africa

BACKGROUND

Evidence suggests that women who give birth in a health facility have lower odds of experiencing pregnancy complications and significantly reduced risk of death from pregnancy-related causes compared to women who deliver at home. Establishing the association between high-risk fertility behaviour (HRFB) and health facility delivery is imperative to inform intervention to help reduce maternal mortality. This study examined the association between HRFB and health facility delivery in West Africa.

METHODS

Data for the study were extracted from the most recent Demographic and Health Surveys of twelve countries in West Africa conducted from 2010 to 2020. A total of 69,479 women of reproductive age (15-49 years) were included in the study. Place of delivery was the outcome variable in this study. Three parameters were used as indicators of HRFB based on previous studies. These were age at first birth, short birth interval, and high parity. Multivariable binary logistic regression analysis was performed to examine the association between HRFB and place of delivery and the results were presented using crude odds ratio (cOR) and adjusted odds ratio (aOR), with their respective 95% confidence interval (CI).

RESULTS

More than half (67.64%) of the women delivered in a health facility. Women who had their first birth after 34 years (aOR = 0.52; 95% CI = 0.46-0.59), those with short birth interval (aOR = 0.91; 95% CI = 0.87-0.96), and those with high parity (aOR = 0.58; 95% CI = 0.55-0.60) were less likely to deliver in a health compared to those whose age at first delivery was 18-34 years, those without short birth interval, and those with no history of high parity, respectively. The odds of health facility delivery was higher among women whose first birth occurred at an age less than 18 years compared to those whose age at first birth was 18-34 years (aOR = 1.17; 95% CI = 1.07-1.28).

CONCLUSION

HRFB significantly predicts women's likelihood of delivering in a health facility in West Africa. Older age at first birth, shorter birth interval, and high parity lowered women's likelihood of delivering in a health facility. To promote health facility delivery among women in West Africa, it is imperative for policies and interventions on health facility delivery to target at risk sub-populations (i.e., multiparous women, those with shorter birth intervals and women whose first birth occurs at older maternal age). Contraceptive use and awareness creation on the importance of birth spacing should be encouraged among women of reproductive age in West Africa.

Intra-regional variations and contextual effects on facility-based delivery in Bangladesh: A multi-level analysis

We examined intra-regional variations and contextual influences on institutional delivery of women using the nationally representative 2014 Bangladesh Demographic and Health Survey data. Due to the hierarchical structure of the data, we employed multi-level logistic regression analysis. Of the women who had had a live birth in the last three years preceding the survey, only 38% availed the opportunity of institutional delivery. From the findings of this study, we observed that women of the Eastern region were less likely and those of the Western region were more likely to use FBD compared to the women of the Central region. Both individual- and community-level factors influence women to use facility-based delivery. Community-level programs aimed at improving availability and easy accessibility to economically deprived and geographically disadvantaged areas may increase safe motherhood practices among women.

Determinants and Trends of Health Facility Delivery in Bangladesh: A Hierarchical Modeling Approach

Background

Most maternal deaths occur during childbirth and after childbirth. This study was aimed at determining the trends of health facilities during delivery in Bangladesh, as well as their influencing factors.

Methods

This study used secondary data from three Bangladesh Multiple Indicator Cluster Surveys (MICSs) in 2006, 2012–13, and 2019. The study's target sample was those women who gave birth in the last two years of the survey. A two-level logistic regression was applied to determine the effects on health facility delivery separately in these two survey points (MICSs 2012–13 and 2019).

Results

The results show that the delivery of health facilities has increased by almost 37.4% in Bangladesh, from 16% in 2006 to 53.4% in 2019. The results of two-level logistic regression show that the total variation in health facility delivery across the community has decreased over recent years. After adding community variables, various individual-level factors such as women with secondary education (OR = 0.55 in 2012-13 vs. OR =0.60 in 2019), women from middle wealth status (OR = 0.49 in 2012-13 vs. OR = 0.65 in 2019), religion, and child ever born showed a strong relationship with health facility delivery in both survey years. At the community level, residents showed significant association only in the 2012-13 survey and indicated a 43% (OR = 1.43 for 2012-13) greater availability of health facilities in urban residences than in rural residences. Using media showed a highly significant connection with health facility delivery in both years as well as an increasing trend over the years in Bangladesh (OR = 1.19 in 2012-13 vs. OR = 1.38 in 2019). However, division, prenatal care, and skilled services all contribute greatly to increasing the delivery of health facilities in Bangladesh.

Conclusions

The results of this study suggest that policymakers need to pay attention to individual and community-level factors, especially women's education, poverty reduction, and adequate prenatal care provided by well-trained caregivers.

Do Predictors of Health Facility Delivery Among Reproductive-Age Women Differ by Health Insurance Enrollment? A Multi-Level Analysis of Nigeria's Data

This study aims to compare determinants of health facility delivery for women under a health insurance scheme and those not under a health insurance scheme. Secondary data drawn from the National Demographic and Health Survey was used for the analysis. The characteristics of the women were presented with simple proportions. Binary multilevel logistic regression was used to examine the determinants of health facilities for women who enrolled in health insurance and those who did not. All statistical analyses were set at 5% level of significant level (p = 0.24). The result showed that 2.1% of the women were under a health insurance scheme. Disparity exists in health insurance ownership as a higher proportion of those enrolled in health insurance were those with higher education attainment, in urban parts of the country, and those situated on higher wealth quintiles. There is a significant difference between those with and those without health insurance. It implies that a higher proportion of women who enrolled in health insurance delivered in health facility delivery compared to those who do not. The unique determinants of health facility delivery for women under health insurance were parity and birth order, while unique determinants of health facility delivery for women not enrolled in health schemes were employment status, marriage type, and geopolitical zones. Uniform predictors of health facility delivery for both groups of women were maternal education, household wealth quintiles, autonomy on healthcare, number of antenatal contacts, residential status, community-level poverty, community-level media use, and community-level literacy. Intervention programs designed to improve health facility delivery should expand educational opportunities for women, improve household socioeconomic conditions, target rural women, and encourage women to undertake a minimum of four antenatal contacts.

Do the determinants of institutional delivery among childbearing women differ by health insurance enrolment? Findings from a population-based study in Nigeria

Studies in Nigeria have identified several individual and contextual determinants of institutional delivery among childbearing women. However, it is not clear in literature whether these determinants are peculiar to women who enrolled or do not enrolled in health insurance schemes. This study compares the determinants of institutional delivery among childbearing women who either enrolled or do not enrolled in health insurance schemes in Nigeria. The study was based on women's data from the 2018 Nigeria Demographic and Health Survey. A weighted sample size of 17,465 women was analysed. Stata 14 was used to perform data analysis. Three binary logistic regression models were estimated. Results show higher prevalence of institutional delivery among women who enrolled in health insurance (39.3% vs. 70.5%). Result further reveal differences in the determinants of institutional delivery among the women with sex of head of household (adjusted odds ratio [AOR] = 1.340, p < 0.05; 95% CI: 1.121-1.602), type of marriage (AOR = 0.817, p < 0.05; 95% CI: 0.727-0.918) and status of most recent delivery (AOR = 0.703, p < 0.001; 95% 95% CI: 0.631-0.781) showing significance among women not enrolled in health insurance but insignificant among women enrolled in health insurance. Differences in determinants of institutional delivery among the women may be attributed to differences in their socio-demographic condition.

Individual and community socioeconomic factors related to the quality of antenatal care: a multilevel analysis of West and Central Africa

Antenatal care (ANC) can improve maternal health. We examined associations of individual and community socioeconomic status (SES) with the quality of ANC in West and Central Africa. Data were from the 2009-2011 UNICEF Multiple Indicator Cluster Surveys for women in seven countries (n = 24,718). Individual SES variables included women's education and wealth; community SES was defined as low or high poverty index. ANC quality was defined as receiving six services: blood pressure monitoring, blood tests, urine tests, malaria prophylaxis, tetanus vaccine, and HIV screening, and coded low or high. We used multilevel logistic regression to estimate fixed and random effects of individual and community SES on ANC quality. Less than one-fourth of women received high-quality ANC. Only small percentages of women had malaria prophylaxis and were counseled and tested for HIV. In adjusted country-stratified results, living in a poor community was associated with reduced odds of receiving high-quality ANC in six countries (Central African Republic: odds ratio, OR = 0.76; 95% confidence interval, CI:0.58-0.98; Chad: OR = 0.48; CI:0.32-0.74; Ghana: OR = 0.86; CI:0.61-0.97; Nigeria: OR = 0.74; CI:0.61-0.92; Sierra Leone: OR = 0.71; CI:0.57-0.91; and Togo: OR = 0.80; CI:0.47-0.91). The health system may be missing important opportunities to provide high-quality ANC and, thereby, improve pregnancy outcomes in these settings.

Social determinants of mammography screening among women aged 50 to 59, Peru 2015

Breast cancer (BC) screening could reduce its mortality; however, its access is influenced by societal forces. Our objective is to identify the social determinants associated with mammography screening (MS) in women aged 50 to 59 in Peru. In this cross-sectional analysis of the Peruvian Demographic Health Survey, 2015, MS within the past two years was evaluated through self-report. Prevalence for MS was 21.9% [95% CI: 18.9 to 25.1]. The average age was 54 years (s.d.: 2.5). The higher the socioeconomic status, the higher the prevalence of screening (3.2% vs 41.4% in extreme quintiles, p < .001). In the adjusted models, higher socioeconomic status (PR: 5.81, 95% CI: 2.28 to 14.79), higher education level (PR: 2.03, 95% CI: 1.30 a 3,15) and having health insurance from the Ministry of Health (PR: 2.21, 95% CI: 1.28 to 3.82) and EsSalud (PR: 4.37, 95% CI: 2.67 to 7.15), were positively associated with MS. Social inequalities in screening access exist and might translate into inequalities in cancer morbidity and mortality. The Peruvian government urgently needs to improve screening rates in these vulnerable populations.