BITAKWITSE LESTINE is a psychologist with Masters in Health Services Research from Makerere University College of Health Sciences. Lestine has experience in research implementation (team leadership) and quality improvement at facility and community levels in projects funded by WHO, USAID, UN and MOH. Currently, her interests lie in health systems strengthening, research and disease surveillance.
Dissertation title: Determinants of health facility based delivery among women in urban slums of Kampala Uganda.
Background: High maternal and neonatal mortality is still a public health concern in low income countries. And pregnant women inhabiting urban slums are high risk group with limited access to health facilities. In Uganda utilization of ANC is quite high at 95% but health facility based births is low at 57%.
Objective: The study examined the frequency and determinants of facility based deliveries among women in urban slums of Kampala.
Methods: A mixed methods study design with both quantitative and qualitative methods was used. In the cross-sectional study design, multistage sampling was used to select a total of 420 mothers who had delivered in the past one year preceding the survey. A pre-tested interviewer administered questionnaire and Focus Group Discussion guide were used with women aged 15-49. Stata 10 software was used to analyze the quantitative data. Ordinary Logistic regression was used at multivariable analysis to determine independent predictors in utilization of health facilities at delivery. Qualitative data analysis was done manually using content analysis to code the responses into sub-themes and themes as some of the reported statements were quoted verbatim to give exact meaning.
Results: Over all, the utilization of health facility based births was 66.1% and ANC attendance was 95.7%. The factors that significantly influenced facility based delivery among urban poor were exposure to media OR 2.5(1.6-3.9), frequency of ANC attendance for less than 4 times OR=0.6 95% CI (0.3-0.9) and timing of first ANC visit in the 2 and 3rd trimesters of pregnancy OR 0.5 95% CI (0.3-0.8). From FGDs the factors commonly highlighted by mothers as facilitators to health facility based delivery are free cost of care and nearby public health facilities. However, barriers included poor reception and handling of laboring mothers, lack of privacy, poor competence and attitudes of health workers, lack of facility equipment or materials, hidden cost of care, limited transport options and too many supplies required at delivery like gloves and baby clothing’s.
Conclusion and recommendations; This study demonstrated that utilization of maternal health services (antenatal and delivery services) were relatively high in the study area. The most important factors influencing the use of health facilities at delivery are media exposure, timing of ANC, and frequency of ANC visits, facility and economic barriers. There is need to improve media exposure among mothers, promote health education programs on the benefits of early initiation of ANC, attending ANC at least four times, availing ambulances, change of health workers attitudes and improving facility equipment and materials.