Determinants of compliance of mothers to referrals for skilled delivery attendance by village health teams in Abim district, Uganda
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ABSTRACT Background: Although maternal mortality ratio (MMR) in Uganda has reduced from 438 to 336 per 100,000 live births over the last six years, MMR in Karamoja region remains high at 750 per 100,000 live births. These deaths are usually due to preventable causes. Worse still, only 55% utilize skilled birth attendance. This study was designed to establish the determinants of compliance of mothers to the referral for skilled delivery attendance by Village Health Teams in Abim district. Methods: This was a cross-sectional study of 386 mothers who delivered between 1st January 2012 and 31st December 2012 in Abim district. Six parishes were selected using simple random sampling. Data was entered and analysed using SPSS version 23.0. Descriptive statistics was used to analyse socio-demographic characteristics and bivariable analysis for factors associated with compliance to skilled delivery attendance using chi-square test. Multivariable logistic regression using Modified Poisson Regression and association tested using Prevalence Ratio at 95% CI and level of significance of p<0.05. To elicit views and perceptions on compliance to skilled birth attendance, qualitative data was collected using key informant interviews (KIIs) among 3 health workers and Focused Group Discussions (FGDs) among 3 VHTs groups of 9, 9 and 11 to a total of 29 and 2 community/opinion leaders at village level of 7 and 8 to a total of 15. Thematic- content analysis was used to analyse qualitative data. Results: Out of 386 pregnant women, most of the mothers 184 (47.7%) were aged between 18 and 25 years old with only 3.4% (13) aged less than 18 and 11.4% (44) aged 36 years old and above. Over a third of the mothers; 36.0% (139/386) were visited by VHTs during pregnancy and of these, 88.5% (123/139) were referred for skilled delivery attendance with a compliance of 62.6% (77/123) and 43.1% (53/123) of which were provided with formal referral forms. Only 41.5% (22/53) of the formally referred mothers received completed referral feedback from skilled delivery attendants. Factors that were significantly associated with compliance to VHT referrals were; mothers who received support from the family members to reach health facility (APR = 4.92 95% CI: 1.63-8.63) and distance from the nearest health facility to the mother’s home >5km (APR = 0.45 95% CI: 0.02-0.98). Conclusion:The compliance of mothers to the referral for skilled delivery attendance (SDA) was suboptimal in Abim district. Family support and distance to nearest health facility are the key factors that affect compliance to referral to skilled birth attendance. It is now very important that the community leaders foster awareness on the importance of skilled delivery attendance and encourage family support for the same. The district should invest in strengthening the capacity of VHTs to execute their functions and enhance the capacity of the level II heal facilities to provide basic EmOC services to reduce the distance for pregnant women so as to access and utilize timely EmOC services. Technical supervision and support to the district and the lower level health units towards motivating and supporting the VHT structures for optimum maternal and child health community outputs is very much recommended.