ArticleBMC public health2025
Multilevel and spatial analysis of factors influencing non-institutional delivery care utilization among Ugandan women: insights from the 2016 UDHS.
Article in BMC public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundWhile Uganda has made notable strides in increasing facility-based deliveries, a significant proportion of women approximately 25% still give birth outside health institutions. This pattern contributes to the country's high maternal mortality rate, estimated at 336 deaths per 100,000 live births. This study explores both individual and community-level determinants of non-institutional delivery, along with its spatial distribution across Uganda.
methodsThe analysis draws on data from the 2016 Uganda Demographic and Health Survey (UDHS), focusing on a weighted sample of 9,630 women aged 15-49 who had given birth within the five years preceding the survey. The data were collected through a multistage stratified sampling approach. A multilevel logistic regression model was used to examine the predictors of non-institutional delivery, analyzed using STATA version 14.2. Spatial patterns were assessed using ArcGIS 10.6.1 and SaTScan 10.1.3.
resultsKey individual-level factors associated with higher odds of non-institutional delivery included being previously married, having two or more children, and reporting an unintended pregnancy. Conversely, women with secondary or higher education, those in the middle or upper wealth quintiles, those who had four or more antenatal care visits, and those who received high-quality antenatal services were less likely to deliver outside a health facility. At the community level, lower odds of non-institutional delivery were observed among women living in the Northern region, in communities with better access to health facilities, and in areas with higher media exposure. Spatial analysis revealed significant clusters of non-institutional deliveries in the Western and Eastern regions, with some spread into the Northern and Central regions.
conclusionsNon-institutional deliveries in Uganda are shaped by a combination of individual and community-level factors, with clear spatial disparities. Policy interventions should prioritize expanding access to secondary education, improving the quality and reach of maternal healthcare services, enhancing infrastructure, and addressing socioeconomic inequalities to reduce non-institutional deliveries.
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