Inequity in utilization of health care facilities during childbirth: a community-based survey in post-conflict Northern Uganda
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Journal of Public Health
Abstract
To assess inequity in utilization of health care facilities during childbirth and factors associated with home births in Lira
district, Northern Uganda.
Subjects and methods In 2016, we surveyed 930 mothers with children under the age of 2 years in Lira district, Northern
Uganda. We used multiple correspondence analysis to construct the wealth index in quintiles, based on household assets. The
concentration index is the measure of socioeconomic inequality used in this article, which we calculated using the Stata DASP
package. We also conducted multivariable logistic regression to assess factors associated with home births.
Results A third of mothers (n = 308) gave birth from home [33%, 95% confidence interval (CI) (26%–41%)]. Giving birth at a
health facility was pro-rich with a concentration index of 0.10 [95% CI (0.05–0.14)]. Upon decomposing the concentration index,
the most important determinant of inequity was the mother's residence. Factors associated with home births in multivariable
logistic regression included rural residence [adjusted odds ratio (AOR) 3.1, 95%CI (1.8–5.3)], precipitate labor [AOR 4.18, 95%
CI (2.61–6.71)], and labor starting in the evening or at night. Mothers who had previously given birth from home were more
likely to give birth at home again [AOR 40.70, 95% CI (18.70–88.61)], whereas mothers who had experienced a complication
during a previous birth were less likely to give birth at home [AOR 0.45, 95% CI (0.28–0.95)]. Conclusion There was inequity in the utilization of health facilities for childbirth. Programs that promote health facility births
should prioritize poorer mothers and those in rural areas.
Description
Keywords
Inequity, Home births, Post-conflict, Health facility birth, Hospital delivery
Citation
Mukunya, D., Tumwine, J. K., Ndeezi, G., Tumuhamye, J., Tongun, J. B., Kizito, S., ... & Nankabirwa, V. (2021). Inequity in utilization of health care facilities during childbirth: a community-based survey in post-conflict Northern Uganda. Journal of Public Health, 29, 229-237. https://doi.org/10.1007/s10389-019-01114-z