Factors affecting home delivery in rural Tanzania

Abstract

Summarybackground Studies of factors affecting place of delivery have rarely considered the influence of gender roles and relations within the household. This study combines an understanding of gender issues relating to health and help-seeking behaviour with epidemiological knowledge concerning place of delivery.methods In-depth interviews, focus group discussions and participant observation were used to explore determinants of home delivery in southern Tanzania. Quantitative data were collected in a crosssectional survey of 21 600 randomly chosen households.results Issues of risk and vulnerability, such as lack of money, lack of transport, sudden onset of labour, short labour, staff attitudes, lack of privacy, tradition and cultures and the pattern of decision-making power within the household were perceived as key determinants of the place of delivery. More than 9000 women were interviewed about their most recent delivery in the quantitative survey. There were substantial variations between ethnic groups with respect to place of delivery (P < 0.0001). Women who lived in male-headed households were less likely to deliver in a health facility than women in female-headed households (RR 0.86, 95% CI 0.80-0.91). Mothers with primary and higher education were more likely to deliver at a health facility (RR 1.30, 95% CI 1.23-1.38). Younger mothers and the least poor women were also more likely to deliver in a health facility compared with the older and the poorest women, respectively.conclusions To address neonatal mortality, special attention should be paid to neonatal health in both maternal and child health programmes. The findings emphasize the need for a systematic approach to overcome health-system constraints, community based programmes and scale-up effective low-cost interventions which are already available.

Understanding home-based neonatal care practice in rural southern Tanzania

“…Delivery at health facilities needs to be more easily accessible (Campbell and Graham, 2006;Koblinsky, 2006;Ronsmans and Graham, 2006), although it should be noted that there is a major shortage of skilled birth attendants at peripheral health facilities in our study area. Our observations suggest that even mothers who are aware of the health risks in childbirth have problems accessing good care at health facilities due to lack of money, poor transport, abusive language and drug shortages (Mrisho et al, 2007). Moreover, health staff give more emphasis to advising primigravidae to give birth in a facility than to multigravid mothers.…”

“…More than half (58%) of births are at home (Mrisho et al, 2007). Trained and untrained TBAs assist 16% and 40% of births in Lindi and Mtwara, respectively.…”

“…The study area is well described elsewhere (Mrisho et al, 2007). In brief, the area has a wide mix of ethnic groups, the most common being Yao, Makonde, Mwera and Matumbi.…”

On the way to universal coverage of maternal services in Iringa rural District in Tanzania. Who is yet to be reached?

“…First, as in other published work 7,12 , SBA has been approximated to health facility delivery, yet some facilities lack staff who can provide SBA 2 . Asking women about their attendant could have addressed this, but there is evidence of inaccurate identification of attendants' skill level by women 25 .…”

“…ANC is in turn a determinant of SBA. In Tanzania, studies in areas of intermediate coverage have found SBA to be significantly associated with distance to facility in two studies, and with socio-economic status (SES) in one study, but not in others 6,[11][12][13] . No published studies have addressed quantitative determinants of ANC in Tanzania.…”