Examining the roles of “significant others” and the associated factors in the uptake of health facility delivery in lira district, Uganda.
NYACHWO, EVELYNE BAELVINA
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Background: Health facility delivery is one of the interventions being implemented worldwide to improve maternal and new-born health outcomes. Despite Uganda’s remarkable improvement, more effort is needed in Lira District whose uptake is lower than the national average. A number of individual, community and health system factors associated with the roles of “significant others” in the uptake of health facility deliveries have been studied globally, regionally and nationally. However, less has been studied locally in Lira District on the roles of “significant others” and the factors associated with their roles in the uptake of health facility delivery. General objective: This study assessed the roles of “significant others”" and the associated factors with their roles in the uptake of health facility delivery in Lira District. Methods: This was a cross sectional study that employed mixed methods of data collection. It was conducted in four purposively selected sub-counties in Lira District. Mothers who had delivered within 2 years prior to the start of data collection were randomly selected and interviewed using a semi-structured questionnaire. Mothers who participated in quantitative interviews identified their “Significant others” who were purposively selected for in-depth interviews. Key informant interviews were conducted with purposively selected health workers. Quantitative data were analysed using SPSS version 23.0. The outcome variable were the five different roles of “significant others” which were independently analysed in separate models. Associations between each role and the independent variables were analysed using binary logistic regression. Factors that were significantly associated with the outcome (p<0.05) were included in the multivariable model. Significant associations were presented using adjusted odds ratios at a 95% confidence interval. Qualitative data were analysed using thematic analysis and results were presented verbatim using quotes. Results: Of the 522 mothers, (403/522, 77.2%) delivered from a health facility. The identified “significant others” included; husbands, mothers, mothers-in-law, siblings, friends and fatherin-law and health workers. Their roles were: planning for birth, providing financial support, decision making and counselling of mothers. Significantly associated with the roles of “significant others” were; distance from health facility (AOR=0. 61, 95% CI: 0.42- 0.88), affordability of health facility delivery (AOR=0.504, 95% CI: 0.28- 0.88), satisfaction with health care services and education level of mother. Main bread winner in the home (AOR=1.78, xiv 95% CI: 1.11- 2.87), and number of people living in the household (AOR=2.17, 95% CI: 1.024.61). In the qualitative results, additional of “significant others” included: local council leaders, village health teams, neighbours and traditional birth attendants. Additional roles of “significant others” were: accompanying mothers to a delivery place and providing support in her domestic roles and child care responsibilities. Conclusion: The uptake of health facility delivery was slightly higher (77.2%) than the national average 73% (UDHS, 2016). Husbands (also identified as the key “significant others”) were often not available to support mothers. Efforts to further enhance and maintain health facility deliveries should target other key persons in the mother’s life to provide additional support in the absence of husbands.