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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
"not too far to walk": The influence of distance on place of delivery in a western Kenya health demographic surveillance system
BMC Health Services Research, Volume 14, No. 1, Article 212, Year 2014
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Description
Background: Maternal health service coverage in Kenya remains low, especially in rural areas where 63% of women deliver at home, mainly because health facilities are too far away and/or they lack transport. The objectives of the present study were to (1) determine the association between the place of delivery and the distance of a household from the nearest health facility and (2) study the demographic characteristics of households with a delivery within a demographic surveillance system (DSS). Methods. Census sampling was conducted for 13,333 households in the Webuye health and demographic surveillance system area in 2008-2009. Information was collected on deliveries that had occurred during the previous 12 months. Digital coordinates of households and sentinel locations such as health facilities were collected. Data were analyzed using STATA version 11. The Euclidean distance from households to health facilities was calculated using WinGRASS version 6.4. Hotspot analysis was conducted in ArcGIS to detect clustering of delivery facilities. Unadjusted and adjusted odds ratios were estimated using logistic regression models. P-values less than 0.05 were considered significant. Results: Of the 13,333 households in the study area, 3255 (24%) reported a birth, with 77% of deliveries being at home. The percentage of home deliveries increased from 30% to 80% of women living within 2km from a health facility. Beyond 2km, distance had no effect on place of delivery (OR 1.29, CI 1.06-1.57, p = 0.011). Heads of households where women delivered at home were less likely to be employed (OR 0.598, CI 0.43-0.82, p = 0.002), and were less likely to have secondary education (OR 0.50, CI 0.41-0.61, p < 0.0001). Hotspot analysis showed households having facility deliveries were clustered around facilities offering comprehensive emergency obstetric care services. Conclusion: Households where the nearest facility was offering emergency obstetric care were more likely to have a facility delivery, but only if the facility was within 2km of the home. Beyond the 2-km threshold, households were equally as likely to have home and facility deliveries. There is need for further research on other factors that affect the choice of place of delivery, and their relationships with maternal mortality. © 2014Mwaliko et al.; licensee BioMed Central Ltd.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC4036729/bin/1472-6963-14-212-S1.pdf
Authors & Co-Authors
Mwaliko, Emily
Kenya, Eldoret
Moi University
Downing, Raymond V.
Kenya, Eldoret
Moi University
O'Meara, Wendy Prudhomme
United States, Durham
Duke University School of Medicine
Chelagat, Dinah
Kenya, Eldoret
Moi University
Obala, Andrew Ambogo
Kenya, Eldoret
Moi University
Downing, Timothy A.
United States, Washington, D.c.
Usda Forest Service
Simiyu, Chrispinus J.
Kenya, Eldoret
Moi University
Odhiambo, David
Kenya, Eldoret
Moi University
Ayuo, Paul O.
Kenya, Eldoret
Moi University
Menya, Diana
Kenya, Eldoret
Moi University
Khwa-Otsyula, Barasa O.
Kenya, Eldoret
Moi University
Statistics
Citations: 50
Authors: 11
Affiliations: 3
Identifiers
Doi:
10.1186/1472-6963-14-212
e-ISSN:
14726963
Research Areas
Health System And Policy
Maternal And Child Health
Study Approach
Quantitative
Study Locations
Kenya
Participants Gender
Female