ArticleBMJ global health2024
Inequalities in use of hospitals for childbirth among rural women in sub-Saharan Africa: a comparative analysis of 18 countries using Demographic and Health Survey data.
Article in BMJ global health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
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Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Methods to derive composite indicators used for quality and safety measurement and monitoring in healthcare: a scoping review.Frontiers in health services · 2026Pooled it
- Evaluating the Adoption of mHealth Technologies by Community Health Workers to Improve the Use of Maternal Health Services in Sub-Saharan Africa: Systematic Review.JMIR mHealth and uHealth · 2024Pooled it
- Prediction of low 5-minute Apgar scores: development and internal validation of parity-stratified clinical prediction models for sub-Saharan Africa.BMC pregnancy and childbirth · 2026Article
- Prevalence and factors associated with institutional delivery in rural Afghanistan: secondary analysis of the 2022-2023 multiple indicator cluster survey.Reproductive health · 2026Article
- Where Women Give Birth Is Changing in Sub-Saharan Africa: Evidence From 30 Countries Using DHS Data.Journal of pregnancy · 2026Article
- The use of Childbirth Experience Questionnaire (CEQ) and Birth Satisfaction Scale-Revised (BSS-R) in comparing the experiences of mothers with and without HIV in Tanzania.BMJ global health · 2025Article
- Analysis of the most common causes of blood donor deferral in Southern Mozambique.BMC infectious diseases · 2025Article
- Global dominance of non-institutional delivery and the risky impact on maternal mortality spike in 25 Sub-Saharan African Countries.Global health research and policy · 2025Article
- Mixed vulnerabilities: the biological risk of high parity is aggravated by emergency referral in Benin, Malawi, Tanzania and Uganda.International journal for equity in health · 2025Article
- Grand multiparity and its associated factors in Zambia: Evidence from the 2018 Zambia Demographic and Health Survey.PLOS global public health · 2025Article
- A time-stratified, case-crossover study of heat exposure and perinatal mortality from 16 hospitals in sub-Saharan Africa.Nature medicine · 2024Article
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Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionRising facility births in sub-Saharan Africa (SSA) mask inequalities in higher-level emergency care-typically in hospitals. Limited research has addressed hospital use in women at risk of or with complications, such as high parity, linked to poverty and rurality, for whom hospital care is essential. We aimed to address this gap, by comparatively assessing hospital use in rural SSA by wealth and parity.
methodsCountries in SSA with a Demographic and Health Survey since 2015 were included. We assessed rural hospital childbirth stratifying by wealth (wealthier/poorer) and parity (nulliparity/high parity≥5), and their combination. We computed percentages, 95% CIs and percentage-point differences, by stratifier level. To compare hospital use across countries, we produced a composite index, including six utilisation and equality indicators.
resultsThis cross-sectional study included 18 countries. In all, a minority of rural women used hospitals for childbirth (2%-29%). There were disparities by wealth and parity, and poorer, high-parity women used hospitals least. The poorer/wealthier difference in utilisation among high-parity women ranged between 1.3% (Mali) and 13.2% (Rwanda). We found use and equality of hospitals in rural settings were greater in Malawi and Liberia, followed by Zimbabwe, the Gambia and Rwanda. DISCUSSION: Inequalities identified across 18 countries in rural SSA indicate poor, higher-risk women of high parity had lower use of hospitals for childbirth. Specific policy attention is urgently needed for this group where disadvantage accumulates.
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