Bypassing birth centres for childbirth: an analysis of data from a community-based prospective cohort study in Nepal

Karkee, Rajendra; Lee, Andy H.; Binns, Colin

doi:10.1093/heapol/czt090

Cited by 56 publications

(114 citation statements)

References 23 publications

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“…Studies from Nepal (1), Tanzania (2, 3), Afghanistan (4), and Uganda (5) have shown that women often circumvent their nearest obstetric care (OC) facility for childbirth. Reports suggest that bypassing by parturients varies in different settings.…”

Section: Introductionmentioning

confidence: 99%

“…Reports suggest that bypassing by parturients varies in different settings. It can range from 41% in Pwani region, Tanzania (2), to 70% in Nepal (1). …”

Section: Introductionmentioning

confidence: 99%

“…For example, younger age (1, 3), primiparity (1, 3, 6), obstetric complications (1, 6), and the distance from the mother's home to the nearest facility have been reported as key individual factors increasing the odds of bypassing a facility for childbirth (3, 6). Conversely, frequent antenatal care (ANC) utilization has been reported to be protective against bypassing (1). Mothers also have higher odds of bypassing a facility if their nearest facility was considered to have inadequate human or supporting resources (i.e.…”

Section: Introductionmentioning

confidence: 99%

“…The quality of the care received at obstetric health facilities is also an important determinant of bypassing. Studies in Nepal and Tanzania have shown a positive association between patients’ low perceived quality of care and bypassing (1, 3). …”

Section: Introductionmentioning

confidence: 99%

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Bypassing health facilities for childbirth: a multilevel study in three districts of Gujarat, India

Salazar

Vora

Costa

2016

Global Health Action

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Background: Bypassing available facilities for childbirth has important implications for maternal health service delivery and human resources within a health system. The results are the additional expenses imposed on the woman and her family, as well as the inefficient use of health system resources. Bypassing often indicates a lack of confidence in the care provided by the facility nearest to the mother, which implies a level of dysfunctionality that the health system needs to address. Over the past decade, India has experienced a steep rise in the proportion of facility births. The initiation of programs promoting facility births resulted in a rise from 39% in 2005 to 85% in 2014. There have been no reports on bypassing facilities for childbirth from India. In the context of steeply rising facility births, it is important to quantify the occurrence of and study the relative contributions of maternal characteristics and facility functionality to bypassing. Objectives: 1) To determine the extent of bypassing health facilities for childbirth among rural mothers in three districts of Gujarat, India, 2) to identify associations between the functionality of an obstetric care (OC) facility and it being bypassed, and 3) to assess the relative contribution of maternal and facility characteristics to bypassing. Design: A cross-sectional survey of 166 public and private OC facilities reporting ]30 births in the 3 months before the survey was conducted in three purposively selected districts (Dahod, Sabarkantha, and Surendranagar) in the state of Gujarat, India. Besides information on each facility, data from 946 women giving birth at these facilities were also gathered. Data were analyzed using a multilevel mixed-effects logistic regression model. Results: Off all mothers, 37.7% bypassed their nearest facility for childbirth. After adjusting for maternal characteristics, for every one-unit increase in the facility's emergency obstetric care (EmOC) signal functions, the odds of bypassing a facility for childbirth decreased by 37% (adjusted odds ratio [AOR] 0.63, 95% confidence interval [CI]: 0.53Á0.76). Conclusions: This study shows that independent of maternal characteristics, in our setting, women will bypass obstetric facilities that are not adequately functional, and travel further to others that are more functional. It is important that the health system should focus on facility functionality, especially in the context of sharply rising hospital births.

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Section: Introductionmentioning

confidence: 99%

“…Reports suggest that bypassing by parturients varies in different settings. It can range from 41% in Pwani region, Tanzania (2), to 70% in Nepal (1). …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Bypassing health facilities for childbirth: a multilevel study in three districts of Gujarat, India

Salazar

Vora

Costa

2016

Global Health Action

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“…Statistical characteristics have been evaluated in terms of bypass percentages [6], average travel distances [7], time periods [8], and costs [9]. Bypass rates vary among areas; for example, in rural America, bypass rates were less than 40% in general [6,10,11], whereas this number was much higher in some undeveloped countries [9,12,13]. Bypass patients pay costs in terms of additional travel distances, travel time and extra financial costs, and most studies have explored why they are willing to pay these costs [14].…”

Section: Introductionmentioning

confidence: 99%

Assessing Patient bypass Behavior Using Taxi Trip Origin–Destination (OD) Data

Yang

Shu

et al. 2016

IJGI

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Abstract:Many patients prefer to use the best hospitals even if there are one or more other hospitals closer to their homes; this behavior is called "hospital bypass behavior". Because this behavior can be problematic in urban areas, it is important that it be reduced. In this paper, the taxi GPS data of Beijing and Suzhou were used to measure hospital bypass behavior. The "bypass behavior index" (BBI) represents the bypass behavior for each hospital. The results indicated that the mean hospital bypass trip distance value ranges from 5.988 km to 9.754 km in Beijing and from 4.168 km to 10.283 km in Suzhou. In general, the bypass shares of both areas show a gradually increasing trend. The following hospitals exhibited significant patient bypass behavior: the 301 Hospital, Beijing Children's Hospital, the Second Affiliated Hospital of Soochow University and the Suzhou Hospital of Traditional Chinese Medicine. The hospitals' reputation, transport accessibility and spatial distribution were found to be the main factors affecting patient bypass behavior. Although the hospital bypass phenomena generally appeared to be more pronounced in Beijing, the bypass trip distances between hospitals were found to be more significant in Suzhou.

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Assessment of Bypass of the Nearest Primary Health Care Facility Among Women in Ghana

Bell

Macarayan²,

Ratcliffe

et al. 2020

JAMA Netw Open

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IMPORTANCE Recent reports have highlighted that expanding access to health care is ineffective at meeting the goal of universal health coverage if the care offered does not meet a minimum level of quality. Health care facilities nearest to patient's homes that are perceived to offer inadequate or inappropriate care are frequently bypassed in favor of more distant private or tertiary-level hospital facilities that are perceived to offer higher-quality care. OBJECTIVE To estimate the frequency with which women in Ghana bypass the nearest primary health care facility and describe patient experiences, costs, and other factors associated with this choice. DESIGN, SETTING, AND PARTICIPANTS This nationally representative survey study was conducted in 2017 and included 4203 households to identify women in Ghana aged 15 to 49 years (ie, reproductive age) who sought primary care within the last 6 months. Women who sought care within the past 6 months were included in the study. Data were analyzed from 2018 to 2019. EXPOSURES Bypass was defined as a woman's report that she sought care at a health facility other than the nearest facility. MAIN OUTCOMES AND MEASURES Sociodemographic characteristics, reasons why women sought care, reasons why women bypassed their nearest facility, ratings for responsiveness of care, patient experience, and out-of-pocket costs. All numbers and percentages were survey-weighted to account for survey design. RESULTS A total of 4289 women met initial eligibility criteria, and 4207 women (98.1%) completed the interview. A total of 1993 women reported having sough health care in the past 6 months, and after excluding those who were ineligible and survey weighting, the total sample included 1946 women. Among these, 629 women (32.3%) reported bypassing their nearest facilities for primary care. Women who bypassed their nearest facilities, compared with women who did not, were more likely to visit a private facility (152 women [24.5%] vs 202 women [15.6%]) and borrow money to pay for their care (151 women [24.0%] vs 234 women [17.8%]). After adjusting for covariates, women who bypassed reported paying a mean of 107.2 (95% CI, 79.1-135.4

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Bypassing birth centres for childbirth: an analysis of data from a community-based prospective cohort study in Nepal

Abstract: The risk of bypassing for childbirth was high in central Nepal. Provision of quality and reliable emergency obstetric services together with well trained and competent staff at birth centres are recommended to reduce bypassing and pressure on the public hospital system.

Cited by 56 publications

References 23 publications

Bypassing health facilities for childbirth: a multilevel study in three districts of Gujarat, India

Bypassing health facilities for childbirth: a multilevel study in three districts of Gujarat, India

Assessing Patient bypass Behavior Using Taxi Trip Origin–Destination (OD) Data

Assessment of Bypass of the Nearest Primary Health Care Facility Among Women in Ghana

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