Choice of Place for Childbirth: Prevalence and Determinants of Health Facility Delivery Among Women in Bahi District, Central Tanzania

Abstract

Maternal and child mortalities are among major health problems facing developing countries such as Tanzania. Most of these deaths can be avoided by utilization of maternity health care services by women, including seeking delivery care services from health professionals in health facilities. This study was carried out in Bahi district in central Tanzania with the aim of evaluating the extent of utilization of health facility for delivery and correlates for its use. The study derives from data collected in a cross-sectional survey conducted in a district in June, 2008 which involved 3,124 randomly chosen households covering all villages of the district. The study involved all women from sampled households’ resident to the area that had ever given birth (delivered) within two years before the survey. A total of 984 women were involved in the study. Data were analyzed for descriptive statistics such as frequencies and percentages; as well as Multiple Logistic Regression for identification of factors associated with delivery in health facility using Statistical Package for Social Sciences (SPSS) version 12. Results from this study indicated that proportion of women in the study population that uses health facility for delivery and hence being attended by skilled birth attendants was still low when compared to the national target (54 vs 80%), indicating more efforts to increase use of health facility for delivery by women in a study population are required. Likelihood (Odds) for delivery in health facility in a most recent birth was significantly higher for women with secondary education and above relative those with primary of no formal education (Odds Ratio (OR) = 2.17; 95% CI, 1.30-3.60); The Odd was also significantly higher for women from high income group compared from those from low income group (OR = 2.3; 95% CI, 1.23-3.97), as well as for women who had at least four antenatal care visits during their last pregnancy relative to those never attended (OR = 1.96; 95% CI, 1.20-3.19). Likelihood for health facility delivery by women decreased significantly with being from other division (location) other than Bahi division (37 to 48% reduction in Odds); also decreased significantly with living more than 10 km from nearest health facility compared to those living within 5 km (OR = 0.62; 95% CI, 0.47-0.81) and being in at least third parity during most recent birth relative to those in first to second parity (OR = 0.74; 95% CI, 0.58-0.94 for 3rd-4th parity; OR = 0.54, 95% CI, 0.35-0.83 for 5th parity and above). Age and marital status at most recent birth, ethnicity, religious affiliation and perceived quality of maternity health care services at nearest health facility by a woman had no effect on odds for reporting delivery in health facility (p>0.05) Based on these findings, recommendations to increase utilization of health facility for delivery by women in a study population have been indicated.