Trends in delivery at a health facility and the associated factors between 2011 and 2015 in Uganda

Abstract

The major objective of this research was to study the factors that influence women’s choice for a place of birth in Uganda and to identify the contributing factors to the changes in delivery at a health facility between 2011 and 2015. Data used for analysis were from community surveys conducted in 2011 and 2015 from 53 districts in Eastern, Western, South Western and Central Uganda. At least 95 women who had delivered within the past 12 months took part in the survey in each district in 2011 and in 2015. Primary factors evaluated were mother’s education level, distance to a health facility, marital status, age, region and residence using a multivariate nonlinear logistic decomposition model to identify and quantify the contribution of individual independent factors to the change in health facility delivery over 2011-2015 and across groups of women residing in rural/urban places. In 2011, 63% delivered at the health facility and this increased to 77% in 2015. The factors associated with delivery at the health facility were education, distance to a health facility, urbanisation of residence and region. It was found out that increase (change) in delivery at a health facility improves over time with women having some education compared to none (p<0.05), urbanisation level, shorter distances (<5km) to a health facility and declines in other regions of the country compared to the central region. Furthermore, the rural-urban difference in percentages of women delivering at a health facility increases mainly because of the influence of having few married women compared to other marital statuses and the effect of having many teen mothers (12-19 years) residing in rural places. Among maternal related factors, changes in distribution of education were significantly (p<0.05) associated with increase in health facility delivery whereas urbanisation and distance to a health facility were the health system related factors which significantly contributed to the increase in health facility delivery. A woman’s region of residence also explained (p<0.05) the choice for health facility delivery both in 2011 and 2015. In order to improve the increase in percentage of mothers who deliver at a health facility over time, the government should intensify campaigns to keep girls in schools up to at least 20 years of age in order to reduce the number of teen mothers especially in rural places and should also build more health facilities in diverse places so that many families live within 5Km to these facilities.