Individual and community level factors associated with health facility delivery: A cross sectional multilevel analysis in Bangladesh

Abstract

Introduction Improving maternal health remains one of the targets of sustainable development goals. A maternal death can occur at any time during pregnancy, but delivery is by far the most dangerous time for both the woman and her baby. Delivery at a health facility can avoid most maternal deaths occurring from preventable obstetric complications. The influence of both individual and community factors is critical to the use of health facility delivery services. In this study, we aim to examine the role of individual and community factors associated with health facility-based delivery in Bangladesh. Methods This cross-sectional study used data from the Bangladesh Maternal Mortality Survey. The sample size constitutes of 28,032 women who had delivered within five years preceding the survey. We fitted logistic random effects regression models with the community as a random effect to assess the influence of individual and community level factors on use of health facility delivery services. Results Our study observed substantial amount of variation at the community level. About 28.6% of the total variance in health facility delivery could be attributed to the differences across the community. At community level, place of residence (AOR 1.48; 95% CI 1.35–1.64), concentration of poverty (AOR 1.15; 95% CI 1.03–1.28), concentration of use of antenatal care services (AOR 1.11, 95% CI 1.00–1.23), concentration of media exposure (AOR 1.20, 95% CI 1.07–1.34) and concentration of educated women (AOR 1.12, 95% CI 1.02–1.23) were found to be significantly associated with health facility delivery. At individual level, maternal age, educational status of the mother, religion, parity, delivery complications, individual exposure to media, individual access to antenatal care and household socioeconomic status showed strong association with health facility-based delivery. Conclusion Our results strongly suggest factors at both Individual, and community level influenced the use of health facility delivery services in Bangladesh. Thus, any future strategy to improve maternal health in Bangladesh must consider community contexts and undertake multi-sectorial approach to address barriers at different levels. At the individual level the programs should also focus on the need of the young mother, the multiparous the less educated and women in the poorest households.

Spatio-temporal distribution and associated factors of home delivery in Ethiopia. Further multilevel and spatial analysis of Ethiopian Demographic and Health Surveys 2005 - 2016

“…Similar findings reported from different studies in Ethiopia, Ghana, and Nigeria (24,26,28,30,33). In line with this finding, this study also evidenced that mothers living in a rural area of Ethiopia were more likely to give birth at home than those living in urban, which is also supported by other studies (30,32,34).…”

Individual-, household-, and community-level factors associated with eight or more antenatal care contacts in Nigeria: Evidence from Demographic and Health Survey

“…In addition, multifactorial inequalities in access to healthcare, impact of environmental, economic, socio-demographic and political factors have contributed to poor health outcomes for women of reproductive age especially in poor resource settings [17]. Studies have identified community-level factors associated with ANC visits, these include rural-urban residential status, years of education/rate of women's literacy, income score/ poverty rate, geographical region, community exposure to newspaper, television, community education and wealth concentration, antenatal care service availability and readiness [13,18,19]. Largely, these factors were examined to determine their association with eight or more ANC contacts in Nigeria.…”

Assessing the Contextual Effect of Community in the Utilization of Postnatal Care Services in Ghana

“…The geographical variation in the non-utilization PNC services may be attributed to inadequate number of health facilities and health professionals in the northern region as suggested the earlier Addai study [55]. Also, media exposure tends to in uence the community's uptake of maternal health services including PNC services based on previous studies [24,33]. The differential usage of PNC services perhaps may be due to the in uential role of cultural values and practices as reported in other studies [56].…”

“…Most importantly, this study found signi cant variability in use of PNC services utilization at the community level independent of individual-level characteristics. The association between communitylevel poverty and use of obstetric care services has long been established in the literature [33,[47][48][49]. Nonetheless, the evidence is somewhat mixed as the results from a previous study that was conducted in the rural part of Tanzania found no substantial association between community-level poverty and utilization of PNC services [23].…”

“…On the other hand, the community poverty level was categorized into two groups as reported in a similar study [33]. The community poverty level variable was created from the wealth index in the survey data.…”