Who is left behind on the road to universal facility delivery? A cross‐sectional multilevel analysis in rural T anzania
Open accessAbstract
Objectives: To examine factors associated with home delivery among women in Pwani Region, Tanzania, which has experienced a rapid rise in facility delivery coverage. Methods: Cross‐sectional data from a population‐based survey of women residing in rural areas of Pwani Region were linked to health facility locations. We fitted multilevel logistic models to examine individual and community factors associated with home delivery. Results: A total of 752 (27.95%) of the 2691 women who completed the survey delivered their last child at home. Women were less likely to deliver at home if they had any primary education [odds ratio (OR) 0.62; 95% confidence interval (CI): 0.50, 0.79], were primiparous (OR: 0.52; 95% CI: 0.37, 0.73), had more exposure to media (OR: 0.80; 95% CI: 0.66, 0.96) or had received more (OR: 0.78; 95% CI: 0.63, 0.96) or better quality antenatal care (ANC) services (OR: 0.48; 95% CI: 0.34, 0.67). Increased wealth was strongly associated with lower odds of home delivery (OR: 0.27; 95% CI: 0.18, 0.39), as was living in a village that grew cash crops (OR: 0.56; 95% CI: 0.35, 0.88). Farther distance to hospital, but not to lower level facilities, was associated with higher likelihood of home delivery (OR 2.49; 95% CI: 1.60, 3.88). Conclusions: Poverty, multiparity, weak ANC and distance to hospital were associated with persistence of home delivery in a region with high coverage of facility delivery. A pro‐poor path to universal coverage of safe delivery requires a greater focus on quality of care and more intensive outreach to poor and multiparous women.
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A woman's perceptions of risk associated with childbirth are likely to be lower and her preference for home birth higher if she has delivered safely at home in the past.
“In contrast, a woman’s perceptions of risk associated with childbirth are likely to be lower and her preference for home birth higher if she has delivered safely at home in the past [33, 44].”
From Impact of smartphone-assisted prenatal home visits on women’s use of facility delivery: Results from a cluster-randomized trial in rural Tanzania (2018) · cites this paper as [44]
Distance from the nearest hospital was not a significant predictor of facility delivery in the model.
“Interestingly however, distance from the nearest hospital was not a significant predictor in our model, which conflicts with a recent study on predictors of facility delivery in Tanzania [44].”
From Impact of smartphone-assisted prenatal home visits on women’s use of facility delivery: Results from a cluster-randomized trial in rural Tanzania (2018) · cites this paper as [44]
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Cites
Revisiting the Behavioral Model and Access to Medical Care: Does it Matter?
Andersen, R. M. (1995) · Journal of Health and Social Behavior · doi:10.2307/2137284 · Cited by 9,831 · see citing works
Filmer, D. P., & Pritchett, L. H. (2001) · Demography · doi:10.2307/3088292 · Cited by 5,843 · see citing works
Multilevel and Longitudinal Modeling Using Stata
Rabe-Hesketh, S., & Skrondal, A. (2005) · Biometrics · doi:10.1111/j.1541-0420.2006.00588_16.x · Cited by 4,626 · see citing works
Kassebaum, N. J., Bertozzi-Villa, A., Coggeshall, M. S., Shackelford, K. A., Steiner, C., Heuton, K. R., Gonzalez-Medina, D., Barber, R., Huynh, C., Dicker, D., et al. (2014) · The Lancet · doi:10.1016/s0140-6736(14)60696-6 · Cited by 1,644 · see citing works
Ahmed, S., Creanga, A. A., Gillespie, D. G., & TSUI, A. O. (2010) · PLoS ONE · doi:10.1371/journal.pone.0011190 · Cited by 867 · see citing works
Babalola, S., & Fatusi, A. (2009) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-9-43 · Cited by 840 · see citing works
Countdown to 2015 decade report (2000–10): taking stock of maternal, newborn, and child survival
Bhutta, Z. A., Chopra, M., Axelson, H., Berman, P., Boerma, T., Bryce, J., Bustreo, F., Cavagnero, E., Cometto, G., Daelmans, B. M. E. G., et al. (2010) · The Lancet · doi:10.1016/s0140-6736(10)60678-2 · Cited by 816 · see citing works
Tanzania Demographic and Health Survey 2010
Macro, I. (2011) · Unspecified eBooks · Cited by 780 · see citing works
Obonyo, J. (2010) · Cited by 732 · see citing works
Filmer, D. (1999) · World Bank policy research working paper · doi:10.1596/1813-9450-1994 · Cited by 722 · see citing works
Utilization of maternal health care services in Southern India
Navaneetham, K., & Dharmalingam, A. (2002) · Social Science & Medicine · doi:10.1016/s0277-9536(01)00313-6 · Cited by 584 · see citing works
Going to scale with professional skilled care
Koblinsky, M., Matthews, Z., Hussein, J., Mavalankar, D. V., Mridha, M. K., Anwar, I., Achadi, E. L., Adjei, S., Padmanabhan, P., & Lerberghe, W. V. (2006) · The Lancet · doi:10.1016/s0140-6736(06)69382-3 · Cited by 488 · see citing works
Lawn, J. E., & Kerber, K. J. (2006) · Cited by 446 · see citing works
Montagu, D., Yamey, G., Visconti, A., Harding, A. L., & Yoong, J. (2011) · PLoS ONE · doi:10.1371/journal.pone.0017155 · Cited by 371 · see citing works
Drivers and deterrents of facility delivery in sub-Saharan Africa: a systematic review
Moyer, C. A., & Mustafa, A. (2013) · Reproductive Health · doi:10.1186/1742-4755-10-40 · Cited by 368 · see citing works
Kruk, M. E., Kujawski, S. A., Mbaruku, G. M., Ramsey, K., Moyo, W., & Freedman, L. P. (2014) · Health Policy and Planning · doi:10.1093/heapol/czu079 · Cited by 368 · see citing works
Self-citationLagarde, M., Haines, A., & Palmer, N. (2009) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008137 · Cited by 352 · see citing works
Factors affecting home delivery in rural Tanzania
Mrisho, M., Schellenberg, J. A., Mushi, A. K., Obrist, B., Mshinda, H., Tanner, M., & Schellenberg, D. (2007) · Tropical Medicine & International Health · doi:10.1111/j.1365-3156.2007.01855.x · Cited by 338 · see citing works
van Eijk, A. M., Bles, H. M., Odhiambo, F., Ayisi, J., Blokland, I. E., Rosen, D. H., Adazu, K., Slutsker, L., & Lindblade, K. A. (2006) · Reproductive Health · doi:10.1186/1742-4755-3-2 · Cited by 291 · see citing works
Contextual Influences on the Use of Health Facilities for Childbirth in Africa
Stephenson, R. B., Baschieri, A., Clements, S., Hennink, M. M., & Madise, N. (2005) · American Journal of Public Health · doi:10.2105/ajph.2004.057422 · Cited by 275 · see citing works
Factors associated with the use of maternity services in Enugu, southeastern Nigeria
Onah, H. E., Ikeako, L. C., & Iloabachie, G. C. (2006) · Social Science & Medicine · doi:10.1016/j.socscimed.2006.04.019 · Cited by 272 · see citing works
Access to emergency and surgical care in sub-Saharan Africa: the infrastructure gap
Hsia, R. Y.-J., Mbembati, N., Macfarlane, S., & Kruk, M. E. (2011) · Health Policy and Planning · doi:10.1093/heapol/czr023 · Cited by 261 · see citing works
Self-citationKitui, J., Lewis, S., & Davey, G. (2013) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-13-40 · Cited by 235 · see citing works
Kruk, M. E., Mbaruku, G. M., Rockers, P. C., & Galea, S. (2008) · Tropical Medicine & International Health · doi:10.1111/j.1365-3156.2008.02173.x · Cited by 204 · see citing works
Self-citationImpact of Conditional Cash Transfers on Maternal and Newborn Health
Singer, D. E., Sturke, R., Gleason, J., et al. (2020) · PubMed · doi:10.17615/y1py-h485 · Cited by 183 · see citing works
Mselle, L. T., Moland, K. M., Mvungi, A., Evjen‐Olsen, B., & Kohi, T. W. (2013) · BMC Health Services Research · doi:10.1186/1472-6963-13-174 · Cited by 175 · see citing works
Effects of the physical accessibility of maternal health services on their use in rural Haiti
Gage, A. J., & Calixte, M. G. (2006) · Population Studies · doi:10.1080/00324720600895934 · Cited by 174 · see citing works
Adjiwanou, V., & Legrand, T. (2013) · Social Science & Medicine · doi:10.1016/j.socscimed.2013.02.047 · Cited by 151 · see citing works
Kruk, M. E., Hermosilla, S., Larson, E., & Mbaruku, G. M. (2014) · Bulletin of the World Health Organization · doi:10.2471/blt.13.126417 · Cited by 138 · see citing works
Self-citationLee, A. C., Cousens, S. N., Darmstadt, G. L., Blencowe, H. K., Pattinson, R., Moran, N. F., Hofmeyr, G. J., Haws, R. A., Bhutta, S. Z., & Lawn, J. E. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-s3-s10 · Cited by 138 · see citing works
Adegoke, A., Utz, B., Msuya, S. E., & van den Broek, N. (2012) · PLoS ONE · doi:10.1371/journal.pone.0040220 · Cited by 131 · see citing works
The prevalence of stillbirths: a systematic review
Say, L., Donner, A. P., Gülmezoglu, A. M., Taljaard, M., & Piaggio, G. G. (2006) · Reproductive Health · doi:10.1186/1742-4755-3-1 · Cited by 117 · see citing works
Access to institutional delivery care and reasons for home delivery in three districts of Tanzania
Exavery, A., Kanté, A. M., Njozi, M., Tani, K., Doctor, H. V., Hingora, A., & Phillips, J. F. (2014) · International Journal for Equity in Health · doi:10.1186/1475-9276-13-48 · Cited by 116 · see citing works
Nesbitt, R. C., Gabrysch, S., Laub, A., Soremekun, S., Manu, A., Kirkwood, B. R., Amenga-Etego, S., Wiru, K., Höfle, B., & Grundy, C. (2014) · International Journal of Health Geographics · doi:10.1186/1476-072x-13-25 · Cited by 115 · see citing works
Kruk, M. E., Rockers, P. C., Mbaruku, G. M., Paczkowski, M. M., & Galea, S. (2010) · Health Policy · doi:10.1016/j.healthpol.2010.05.002 · Cited by 112 · see citing works
Self-citationMills, S., Williams, J. E. O., Adjuik, M., & Hodgson, A. (2008) · Maternal and Child Health Journal · doi:10.1007/s10995-007-0288-y · Cited by 96 · see citing works
Professional assistance during birth and maternal mortality in two Indonesian districts
Ronsmans, C. (2009) · Bulletin of the World Health Organization · doi:10.2471/blt.08.051581 · Cited by 94 · see citing works
Tlebere, P., Jackson, D. J., Loveday, M., Matizirofa, L., Mbombo, N., Doherty, T., Wigton, A., Treger, L., & Chopra, M. (2007) · Journal of Midwifery & Women s Health · doi:10.1016/j.jmwh.2007.03.016 · Cited by 92 · see citing works
Predictors for health facility delivery in Busia district of Uganda: a cross sectional study
Anyait, A., Mukanga, D., Oundo, G. B., & Nuwaha, F. (2012) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-12-132 · Cited by 91 · see citing works
Source of Antenatal Care Influences Facility Delivery in Rural Tanzania: A Population-Based Study
Rockers, P. C., Wilson, M. L., Mbaruku, G. M., & Kruk, M. E. (2008) · Maternal and Child Health Journal · doi:10.1007/s10995-008-0412-7 · Cited by 88 · see citing works
Self-citationHousehold Decision-making about Delivery in Health Facilities: Evidence from Tanzania
Kruk, M. E., Danforth, E. J., Rockers, P. C., Mbaruku, G. M., & Galea, S. (2009) · Journal of Health Population and Nutrition · doi:10.3329/jhpn.v27i5.3781 · Cited by 88 · see citing works
Self-citationTanzania Demographic and Health Survey 2004-2005
Macro, O. (2005) · Cited by 75 · see citing works
Tsawe, M., & Susuman, A. (2014) · BMC Research Notes · doi:10.1186/1756-0500-7-723 · Cited by 73 · see citing works
Ng’anjo Phiri, S., Kiserud, T., Kvåle, G., Byskov, J., Evjen-Olsen, B., Michelo, C., Echoka, E., & Fylkesnes, K. (2014) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-14-219 · Cited by 71 · see citing works
Walker, N., Yenokyan, G., Friberg, I. K., & Bryce, J. (2013) · The Lancet · doi:10.1016/s0140-6736(13)61748-1 · Cited by 71 · see citing works
Guliani, H., Sepehri, A., & Serieux, J. (2012) · Social Science & Medicine · doi:10.1016/j.socscimed.2012.02.008 · Cited by 70 · see citing works
Gebrehiwot, T. G., Sebastiån, M. S., Edin, K. E., & Goicolea, I. (2014) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-14-137 · Cited by 69 · see citing works
FACTORS ASSOCIATED WITH UNFAVOURABLE BIRTH OUTCOMES IN KENYA
Magadi, M. A., Madise, N., & Diamond, I. D. (2001) · Journal of Biosocial Science · doi:10.1017/s0021932001001997 · Cited by 60 · see citing works
Free does not mean affordable: maternity patient expenditures in a public hospital in Bangladesh
Khan, S. H. (2005) · Cost Effectiveness and Resource Allocation · doi:10.1186/1478-7547-3-1 · Cited by 56 · see citing works
Parity and institutional delivery in rural Tanzania: a multilevel analysis and policy implications
Ndao-Brumblay, S. K., Mbaruku, G., & Kruk, M. E. (2013) · Health Policy and Planning · doi:10.1093/heapol/czs104 · Cited by 41 · see citing works
Self-citationDistance to emergency obstetric services and early neonatal mortality in E thiopia
McKinnon, B., Harper, S. B., Kaufman, J. S., & Abdullah, M. (2014) · Tropical Medicine & International Health · doi:10.1111/tmi.12323 · Cited by 37 · see citing works
India: conditional cash transfers for in-facility deliveries
Paul, V. K. (2010) · The Lancet · doi:10.1016/s0140-6736(10)60901-4 · Cited by 36 · see citing works
National institute for medical research
Fulton, D. J. D., & Turkf, D. J. L. (1960) · Transactions of the Royal Society of Tropical Medicine and Hygiene · doi:10.1016/0035-9203(60)90195-4 · Cited by 25 · see citing works
Determinants of utilisation of intrapartum obstetric care services in Cambodia, and gaps in coverage
Chomat, A. M., Grundy, J., Oum, S., et al. (2011) · Global Public Health · doi:10.1080/17441692.2011.572081 · Cited by 15 · see citing works
Levira, F., Gaydosh, L. M., & Ramaiya, A. (2014) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-14-329 · Cited by 1 · see citing works
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Research works printed but not linked: 1
- Kruk ME Hermosilla S Larson E Mbaruku GM Bypassing primary care clinics for childbirth: a cross-sectional study in the Pwani region, United Republic of Tanzania Bulletin of the World Health Organization 2014b 92 246 53 24700992 PMC3967574
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Hackett, K., Lafleur, C., Nyella, P., Ginsburg, O., Lou, W., & Sellen, D. (2018) · PLOS ONE · doi:10.1371/journal.pone.0199400 · Cited by 50 · see citing works
- Authors
- Kruk, M. E., Hermosilla, S., Larson, E., Vail, D., Chen, Q., Mazuguni, F., Byalugaba, B., & Mbaruku, G.
- Affiliations
- Harvard University (US)
- Columbia University (US)
- Ifakara Health Institute (TZ)
- Corresponding author
- Kruk, Margaret E.
- ORCID
- Venue
- Tropical Medicine & International Health
- Publisher
- Wiley
- Published
- 2015-04-30
- Volume
- 20
- Issue
- 8
- Pages
- 1057-1066
- ISSN
- 1360-2276 (ISSN-L)
- 1365-3156
- PMC
- PMC4490971
- OpenAlex
- W1979781213
- Cited by
- 32
- References
- 55
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 1 · 2023: 1 · 2022: 3 · 2021: 4 · 2019: 4 · 2018: 4 · 2017: 5 · 2016: 5 · 2015: 1
- FWCI
- 4.99
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Tropical Medicine & International Health (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Institute of Allergy and Infectious Diseases (1R01 AI093182)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Keywords
- home delivery, institutional delivery, maternal health, prenatal care quality, distance to hospital, poverty, multiparity, primary education, media exposure, cash crops, rural women, Tanzania, universal health coverage
- MeSH terms
- Adult, Cross-Sectional Studies, Data Collection, Female, Health Services Accessibility, Home Childbirth, Hospitals, Humans, Maternal Health Services, Parity, Patient Acceptance of Health Care, Poverty, Pregnancy, Prenatal Care, Surveys and Questionnaires, Rural Population, Tanzania, Logistic Models, Odds Ratio, Health Care Surveys, Delivery, Obstetric, Healthcare Disparities, Multilevel Analysis, Young Adult
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