Title : Prevalence and determinants of health facility-based deliveries among women in urban slum settings: Evidence from Lubaga division, Kampala
Abstract:
Background
Health facility-based delivery (HFD) is a critical intervention for maternal and newborn health. In low- and middle-income countries, the proportion of pregnant women who deliver at health facilities has increased over time. Nevertheless, a proportion of women among urban slum settlers do not use this service. This study aimed to assess the prevalence and factors associated with a HFD among urban slum settlers in Lubaga Division, Kampala city, Central Uganda.
Methods: An analytical community-based cross-sectional study was conducted among 384 women aged 15-49 years who had delivered within two years prior to data collection, selected from randomly sampled households in slum settlements of Lubaga Division. Data were collected using a semi-structured questionnaire and analyzed in Stata 15. HFD was measured as a binary outcome (0= non-facility delivery; 1= facility delivery). Association between independent factors and a HFD were determined by multivariable regression across predisposing, enabling, and need factors based on the Andersen and Newman Health Services Utilization Framework.
Results: Out of the 384 women, 300 delivered in health facilities, representing an estimated prevalence of 78.1% (95% CI: 73.1–82.2). The key factors associated with health facility delivery included; parity, waiting time of less than one hour at the health facility, health worker availability, attending more than four antenatal visits, partner’s post-primary education, positive attitude of health workers and maternal age below 30years.
Recommendations: Community-based training like moving learning beyond hospitals could help students understand real-life health challenges like poor sanitation, limited access to care and cultural practices affecting delivery choices.
Conclusions: Much as most women in Lubaga Division delivered in health facilities, a significant proportion delivered outside health facilities. These findings support targeted multiple interventions.
Implication: Targeted interventions such as; financial assistance programs and improved quality of care may further increase facility-based deliveries.
