A structural equation analysis on the relationship between maternal health services utilization and newborn health outcomes: a cross-sectional study in Eastern Uganda
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Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
BMC pregnancy and childbirth
Abstract
Neonatal and maternal health services have a bearing on neonatal mortality. Direct and indirect
factors affecting neonatal health outcomes therefore require understanding to enable well-targeted interventions.
This study, therefore, assessed the interrelationship between newborn health outcomes and maternal service
utilization factors.
Methods: We investigated maternal health utilization factors using health facility delivery and at least four
Antenatal Care (ANC) visits; and newborn health outcomes using newborn death and low birth weight (LBW). We
used data from a household cross-sectional survey that was conducted in 2015 in Kamuli, Pallisa and Kibuku
districts. We interviewed 1946 women who had delivered in the last 12 months. The four interrelated (Endogenous)
outcomes were ANC attendance, health facility delivery, newborn death, and LBW. We performed analysis using a
structural equation modeling technique.
Results: A history of newborn death (aOR = 12.64, 95% CI 5.31–30.10) and birth of a LBW baby (aOR = 3.51, 95% CI 1.
48–8.37) were directly related to increased odds of newborn death. Factors that reduced the odds of LBW as
a mediating factor for newborn death were ANC fourth time attendance (aOR = 0.62, 95% CI 0.45–0.85),
having post-primary level education (aOR = 0.68, 95% CI 0.46–0.98) compared to none and being gravida
three (aOR = 0.49, 95% CI 0.26–0.94) compared to being gravida one. Mother’s age group, 20–24 (aOR = 0.24,
95% CI 0.08–0.75) and 25–29 years (aOR = 0.20, 95% CI 0.05–0.86) compared to 15–19 years was also
associated with reduced odds of LBW. Additionally, ANC visits during the first trimester (aOR = 2.04, 95% CI 1.
79–2.34), and village health teams (VHTs) visits while pregnant (aOR = 1.14, 95% CI 1.01–1.30) were associated
with increased odds of at least four ANC visits, which is a mediating factor for health facility delivery, LBW
and newborn death. Surprisingly, newborn death was not significantly different between health facility and
community deliveries.Conclusions: Attending ANC at least four times was a mediating factor for reduced newborn death and low
birth weight. Interventions in maternal health and newborn health should focus on factors that increase ANC
fourth time attendance and those that reduce LBW especially in resource-limited settings. Targeting women
with high-risk pregnancies is also crucial for reducing newborn deaths.
Description
Keywords
Interrelationship, Structural equation modeling, Maternal health utilization, Newborn outcomes
Citation
Kananura, R. M., Wamala, R., Ekirapa-Kiracho, E., Tetui, M., Kiwanuka, S. N., Waiswa, P., & Atuhaire, L. K. (2017). A structural equation analysis on the relationship between maternal health services utilization and newborn health outcomes: a cross-sectional study in Eastern Uganda. BMC pregnancy and childbirth, 17(1), 1-12. DOI 10.1186/s12884-017-1289-5