Determinants of health institutional delivery among mothers attending immunization services in Busia district a cross- sectional study

Abstract

Both maternal and neonatal health outcomes improve when skilled personnel provide delivery services within health facilities. Determinants of delivery location are crucial to promoting health facility deliveries and yet health facility delivery rates remain low in most low- and middle- income countries. It is asserted that there is expert consensus that delivery at a health facility substantially reduces the risk of maternal death. They argued that by increasing the use of antenatal care (ANC), postnatal care (PNC) and family planning, the risk of maternal death can be further reduced. Several factors influence the location where women deliver from. Such factors include place of residence, family decision-making regarding place of delivery, ANC attendance, socioeconomic status (SES), trimester of pregnancy, age of woman, parity, transport, placenta disposal, delivery position, complication at last delivery, age of pregnancy, levels of education of the woman and her partner, and valid health insurance. All these tend to be closely related to the context. In eastern region of Uganda, examining such factors could help in improving institutional deliveries. The main objective of this study was to ascertain the determinants of institutional health facility delivery among mothers attending immunization services in Busia district. Methodology: A cross-sectional analytical design, both qualitative and quantitative was used. A sample of 385respondent mothers were interviewed using semi-structured questionnaire. Two focus group discussions (FGDs) each composed of 8 to 12 members were held with mothers. Data was analyzed using SPSS version 25. Ethical considerations in research, obtaining letter of introduction for data collection, clearance from university, and quality controls were well taken care of. The level of institution health facility delivery was good, mothers attending immunization services (post-natal visits)) were asked to state whether or not they deliver in health facility, up to 318( 82.6%) delivered in health facilities, with most of the mothers delivering from government hospitals (50.9%) followed by private hospitals (14.3%). The study found that place of residence of the mothers was associated with health facility delivery (X2 (1) =1.515, p<0.002). Mothers who lived in urban settings were 2.7times more likely to deliver from health facilities than mothers who lived in rural settings [COR=2.686, 95% CI (0.394-1.194)]. Husband’s educational level was found to be a determinant of health facility delivery (X2 (3) =2.054, p<0.006). In comparison with mothers whose husbands had no education, mothers whose husbands had primary education, secondary education and tertiary education were 2.2times (COR=2.249, 95% CI(0.581-8.698)), 1.5times (COR=1.546, 95% CI(0.537-4.453)) and 1.3times (COR=1.329, 95% CI (0.501-3.523)) more likely to deliver from health facility respectively. History of having ever delivered from a health facility was associated with the recent health facility delivery (X2 (1) = 0.076, p<0.007). Similarly, getting partner support for health facility delivery was a determinant for health facility delivery (p<0.003).