Determinants for Choice of  Home Birth over Health Facility Birth among Women of Reproductive Age in Tanzania: An Analysis of Data from the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicator Survey

Moshi, Fabiola Vincent; Mbotwa, Christopher H.

doi:10.21203/rs.3.rs-18240/v3

Cited by 7 publications

(17 citation statements)

References 9 publications

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“…Women with no formal education had more than three times higher odds of having home delivery after ANC visit as compared to women who had higher education. This finding was supported by studies done in Ethiopia [ 9 , 32 , 33 ], Kenya [ 34 ] and Tanzania [ 22 , 35 ]. This mightbe due to that educated women had a better level of understanding about skilled delivery service utilization, healthcare-seeking behavior and maternal survival [ 36 ].…”

Section: Discussionsupporting

confidence: 74%

Spatial variation and factors associated with home delivery after ANC visit in Ethiopia; spatial and multilevel analysis

Ayalew

Liyew²,

Tessema³

et al. 2022

PLoS ONE

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Introduction Institutional delivery is crucial to reduce maternal and neonatal mortality as well as serious morbidities. However, in Ethiopia, home delivery (attended by an unskilled birth attendant) after antenatal care (ANC) visit is highly in practice. Therefore, this study aimed to assess the spatial variation and determinants of home delivery after antenatal care visits in Ethiopia. Method A secondary data analysis was conducted using the 2019 mini Ethiopian demographic and health survey. A total of 2,923 women who had ANC visits were included. Spatial analysis was done by using GIS 10.7 and SaTscan 9.6. The risk areas for home delivery from GIS and spatial scan statistics results were reported. A multi-level logistic regression model was fitted using Stata14 to identify individual and community-level factors associated with home delivery after ANC visit. Finally, AOR with 95% CI and random effects were reported. Result Home delivery after ANC visit was spatially clustered in Ethiopia(Moran’s index = 0.52, p-value <0.01). The primary clusters were detected in Oromia and SNNP region (LLR = 37.48, p < 0.001 and RR = 2.30) and secondary clusters were located in Benishangul Gumuz, Amhara, Tigray and Afar (LLR = 29.45, p<0.001 and RR = 1.54). Being rural resident (AOR = 2.52; 95%CI 1.09–5.78), having no formal education (AOR = 3.19;95% CI 1.11–9.16), being in the poor (AOR = 2.20;95%CI 1.51–3.22) and middle wealth index (AOR = 2.07;95% CI 1.44–2.98), having one ANC visit (AOR = 2.64; 95% CI 1.41–4.94), and living in the agrarian region (AOR = 3.63; 95%CI 1.03–12.77) had increased the odds of home delivery after ANC visit. Conclusion and recommendation Home delivery after ANC visit was spatially clustered in Ethiopia. Factors like maternal education, wealth index, number of ANC visits, residency and region were significantly associated with home delivery after ANC visit. Therefore, it is better to increase the number of ANC contact by giving health education, especially for women with low levels of education and better to improve the wealth status of women. A special strategy is also vital to reduce home delivery after ANC visit in those high-risk regions.

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Section: Discussionsupporting

confidence: 74%

Spatial variation and factors associated with home delivery after ANC visit in Ethiopia; spatial and multilevel analysis

Ayalew

Liyew²,

Tessema³

et al. 2022

PLoS ONE

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“…Most studies on pregnancy and delivery have studied the role of education in influencing women’s health care decisions. 23 , 33 , 34 , 36 , 37 , 39 – 42 , 49 Possible explanations that support our results include educated individuals having better access to health service information and having the ability to evaluate and apply such information, making them more health literate and thus more likely to seek care during pregnancy. These individuals are also likely to belong in richer wealth categories, allowing them to access quality health services better and with greater ease.…”

Section: Discussionmentioning

confidence: 59%

“…The observed association between home delivery and wealth index is consistent with the results of other studies. 34 , 37 , 40 , 41 Women of low economic status are likely to choose birth at home because of associated costs with health facility delivery. 41 The National Health Insurance Program (NHIP) covers health expenses during antenatal period and delivery of women.…”

Section: Discussionmentioning

confidence: 99%

“… 34 , 37 , 40 , 41 Women of low economic status are likely to choose birth at home because of associated costs with health facility delivery. 41 The National Health Insurance Program (NHIP) covers health expenses during antenatal period and delivery of women. 46 However, there are other costs related to pregnancy and delivery that need to be considered and acknowledged when interpreting our findings and when advocating for institutional delivery.…”

Section: Discussionmentioning

confidence: 99%

“…Previous literature similarly reported that multiparity is associated with home delivery with the following possible explanations: larger family sizes demand more time and resources from the mother that could limit her ability to avail of health services, and uneventful deliveries with traditional birth attendants may lower risk perceptions of home delivery. 33 , 41 Because the risk of complications increases with each additional pregnancy, 54 women should be supported throughout pregnancy and delivery to encourage them to continue having institutional deliveries for all their pregnancies. Beyond factors working at the individual level, a newly published research has also demonstrated that localities with ordinances prohibiting home birthing without a skilled birth attendant have higher rates of facility-based births, highlighting the importance of implementing such policies.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence and determinants of home delivery in urban and rural Philippines: Evidence from the 2017 National Demographic and Health Survey

Amit

Pepito

Reyes

et al. 2022

Womens Health (Lond Engl)

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Background: Women’s choice of place of delivery has implications on maternal and child mortality. This study aims to provide an updated and detailed comparison of prevalence and determinants of home delivery in the Philippines, and in urban and rural communities. Methods: Based on data from the 2017 Philippine National Demographic and Health Survey (NDHS), we estimated the prevalence of home delivery and determined factors influencing women’s decision to deliver at home. Analyses were restricted to data from 7229 women who were cohabiting or married, and their last-born child using logistic regression methods for survey data. Results: There remain a considerable proportion of women aged 15–49 years old who delivered at home (17.92% (95% confidence interval (CI): 15.77, 20.30)). More women in rural areas delivered at home (23.53% (95% CI: 20.38, 26.99)) than their counterparts in urban areas (10.72% (95% CI: 8.23, 13.85)), reflecting a significant difference in the home delivery prevalence of women relative to their place of residence. Our regression analyses showed that there is a relatively greater effect observed for the rural population in most of the proximal factors considered including birth order, women’s decision-making power, and emergency preparedness during pregnancy. Wealth index has the most pronounced effect with a significant increase in odds of home delivery among urban and rural women of the lowest wealth categories. Conclusion: The use of institutional childbirth services remains suboptimal in the Philippines with significant disparities between urban and rural communities. Current strategies therefore need to adopt a multi-sectoral approach to address the complex factors influencing women’s decision on place of delivery. Targeted efforts specific to population groups should also be made to contextualize and co-create health care services and solutions that will motivate them to deliver in health facilities.

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Prevalence and risk factors associated with malaria infections at a micro-geographic level in three villages of Muheza district, north-eastern Tanzania

Challe,

Francis,

Seth

et al. 2024

Preprint

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BackgroundDespite a recent reduction in malaria morbidity and mortality, the disease remains a major cause of morbidity and mortality in Tanzania. However, the malaria burden is heterogeneous with a higher burden in some regions compared to others, suggesting that stratification of malaria burden and risk/predictors of infections is critical to guide the proper use of the current and future interventions. This study assessed the prevalence and predictors of /risk factors associated with malaria infections at micro-geographic levels in three villages of Muheza district, Tanga region, north-eastern Tanzania.MethodsA cross-sectional community survey was conducted in three villages; Magoda, Mpapayu, and Mamboleo in Muheza district, Tanga region, north-eastern Tanzania in June 2021. Participants’ demographic, anthropometric, clinical, and malaria protection data were collected during the survey and combined with census data collected in 2013 including housing conditions and socio-economic status (SES). Finger prick blood samples were taken for parasite detection using both microscopy and rapid diagnostic tests (RDT). A generalised estimating equation (GEE) was used to determine the association between the prevalence and predictors/risk factors of malaria infections.ResultsThe survey covered 1,134 individuals from 380 households and most of them (95.2%) reported that they slept under bed nets the night before the survey. By both microscopy and RDT, the prevalence of malaria infections was 19.2% and 24.3%, respectively. The prevalence was significantly higher among school children (aged >5 – 15 years, with 27.3% by microscopy and 37.6% by RDTs) compared to under-fives and adults (aged ≥15 years (p<0.001)). Individuals with a history of fever within 48 hours before the survey and those with fever at presentation (auxiliary temperature ≥37.50C) were more likely to have malaria infections by microscopy (AOR = 1.16; 95% CI, 1.10 – 1.22; p<0.001) and RDTs (AOR = 1.18; 95% CI, 1.13 – 1.23; p<0.001). Participants with high SES and living in good houses (with closed eaves and/or closed windows) were less likely to be infected by malaria parasites as detected by microscopy (AOR =0.97; 95% CI, 0.92 - 1.02; p=0.205) and RDTs (AOR = 0.91; 95% CI, 0.85 - 0.97; p<0.001). Among the three villages, the prevalence of malaria by microscopy ranged from 14.7% to 24.6% and varied significantly but without any clear patterns across villages indicating high heterogeneity and random distribution of malaria at micro-geographic levels (p=0.001).ConclusionThe villages had high prevalence and predictor/risk factors risk of malaria infections including age, sex (male), fever, SES, and housing conditions. High prevalence and risk were among school children (aged ≥5 - 14 years), males, individuals with low SES and a history of fever within 48 hours before the survey, or fever at presentation (with auxiliary temperature ≥37.50C). The prevalence varied over short distances at micro-geographic levels suggesting that causes of such variations need to be established and considered when designing and implementing targeted malaria control interventions.

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Determinants for Choice of Home Birth over Health Facility Birth among Women of Reproductive Age in Tanzania: An Analysis of Data from the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicator Survey

Cited by 7 publications

References 9 publications

Spatial variation and factors associated with home delivery after ANC visit in Ethiopia; spatial and multilevel analysis

Spatial variation and factors associated with home delivery after ANC visit in Ethiopia; spatial and multilevel analysis

Prevalence and determinants of home delivery in urban and rural Philippines: Evidence from the 2017 National Demographic and Health Survey

Prevalence and risk factors associated with malaria infections at a micro-geographic level in three villages of Muheza district, north-eastern Tanzania

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