Menu
Menu
Menu
Menu
Background: The healthcare system in Mozambique is striving to reduce the high maternal and child mortality rates and stay on par with the Sustainable Development Goals (SDG 3.1). A key strategy to curb maternal and child mortality is to promote the use of professional childbirth services proven to be highly effective in averting maternal deaths. Currently, little is known about the use of childbirth services in Mozambique. The present study investigated the prevalence of professional healthcare delivery services and identified their sociodemographic correlates. Methods: This study used cross-sectional data on 7080 women aged 15-49 years who reported having a child during the past 5 years. The data were collected from the 2011Mozambique Demographic and Health Survey. The outcome variables were the choice of childbirth services that included 1) place of delivery (respondent’s home versus health facility), and mode of delivery (caesarean section versus vaginal birth). Data were analyzed using descriptive and multivariate regression methods. Results: The prevalence of health facility and C-section delivery was 70.7 and 5.6%, respectively. There was a difference in the use of professional birthing services between urban and rural areas. Having better educational status and living in households of higher wealth quintiles showed a positive association with the use of facility delivery services among both urban and rural residents. Regarding ethnicity, women of Portugais [2.688,1.540,4.692], Cindau [1.876,1.423,2.474] and Xichangana [1.557,1.215,1.996] had relatively higher odds of using facility delivery services than others. Antenatal care (ANC) visits were a significant predictor of facility delivery services both in urban [OR = 1.655, 95%CI = 1.235,2.218] and rural [OR = 1.265, 95%CI = 1.108,1.445] areas. Among rural women, ANC visit was a significant predictor of C-section delivery [1.570,1.042,2.365]. Conclusion: More than a quarter of the women in Mozambique were not using health facility delivery services, with the prevalence being noticeably lower in the rural areas.
Data for this study were collected from the sixth round of Mozambique Demographic and Health Survey. The survey was conducted by the National Statistical Institute (Instituto Nacional de Estatística) and the Ministry of Health (MISAU). The work was finally supported by United States Agency for International Development of the United America (USAID) with Inner City Fund (ICF) International providing technical assistance. Sample population included eligible men (15–54 years) and women (15–49 years) residing in households in urban and rural areas, excluding institutions such as hospitals, hotels, dorms. Data collection was done through direct interviews using a tablet-type computer (Computer-Assisted Personal Interview) system and this process lasted from June 2011 to November 2011. Sampling was done using multistage cluster technique which involves stratifying the provinces into primary sampling units (PSUs), and then selecting of households each PSUs. Of the 13,964 households initially selected, a total of 13,718 women were finally interviewed, resulting in a 99% response rate. These details are available from the final report of Mozambique 2011 DHS and available here: https://dhsprogram.com/publications/publication-FR266-DHS-Final-Reports.cfm. The outcome variables of interest were: 1) place of delivery: home versus health facility, 2) use of c-section: yes versus no. The selection of explanatory variables was guided by Andersen’s Behavioural Model of Health Service utilization which postulates that healthcare utilization is a function of three major factors: 1) predisposing factors, 2) enabling factors and 3) need factors [22]. For this study, the data were secondary and hence the selection of the explanatory variables in line with the behavioral model was not completely possible. Based on the availability in the dataset, the following are included in the analysis: Age (15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49); Residency (Urban, Rural); Education (No Education, Primary, Secondary, Higher); Husband’s education (No Education, Primary, Secondary, Higher); Occupation (Not Working, Professional/Technical/Managerial, Agricultural – Self Employed); Wealth quintile (Poorest, Poorer, Middle, Richer, Richest); Electronic Media Access (No, Yes); Heard of Family Planning (FP) on the internet (No, Yes); Religion (Islam, Other); Ethnicity (Emakhuwa, Portugais, Xichangana, Cisena, Elomwe, Cindau, Xitswa, Other); Parity (1–5, > 5); Sex of Household Head (Male, Female); Last Child Wanted (Wanted Then, Wanted No More); Place of Delivery (Home, Health facility). Data were analyzed with Stata version 14. Dataset was cleaned by applying the inclusion criteria: experience of at least 1 childbirth in the preceding 5 years. As the surveys used cluster sampling techniques, all analyses were adjusted for this by using the svy command [23]. This command uses the information on sampling weight, strata, and primary sampling unit provided with the datasets. Sample characteristics were described as frequencies and percentages. Prevalence of using facility delivery and C-section (for total, urban and rural sample) was presented as bar charts. The predictors of facility delivery and C-section were measured using multivariate analysis. As both of the variables were dichotomous, we used binary logistic regression models and the results expressed using odds ratios (OR) with 95% confidence intervals (CIs). Each of the outcome variables was analyzed separately for the pooled, urban and rural participants. Model fit statistics were run after the regression analyses using the variance inflation factor (VIF) command. No multi-collinearity was detected as VIF values were below 10 for all the models. All tests were two-tailed and were considered significant at alpha value of 5%.
N/A
