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Inequity in uptake of hospital-based childbirth care in rural Tanzania: analysis of the 2015–16 Tanzania Demographic and Health Survey

Proportions of facility births are increasing throughout sub-Saharan Africa, but obstetric services vary within the health system. In Tanzania, advanced management of childbirth complications (comprehensive emergency obstetric care) is offered in hospitals, while in frontline, primary health care (P...

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Autores principales: Straneo, Manuela, Benova, Lenka, Hanson, Claudia, Fogliati, Piera, Pembe, Andrea B, Smekens, Tom, van den Akker, Thomas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8505858/
https://www.ncbi.nlm.nih.gov/pubmed/34279643
http://dx.doi.org/10.1093/heapol/czab079
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author Straneo, Manuela
Benova, Lenka
Hanson, Claudia
Fogliati, Piera
Pembe, Andrea B
Smekens, Tom
van den Akker, Thomas
author_facet Straneo, Manuela
Benova, Lenka
Hanson, Claudia
Fogliati, Piera
Pembe, Andrea B
Smekens, Tom
van den Akker, Thomas
author_sort Straneo, Manuela
collection PubMed
description Proportions of facility births are increasing throughout sub-Saharan Africa, but obstetric services vary within the health system. In Tanzania, advanced management of childbirth complications (comprehensive emergency obstetric care) is offered in hospitals, while in frontline, primary health care (PHC) facilities (health centres and dispensaries) mostly only routine childbirth care is available. With over half (54%) of rural births in facilities, we hypothesized the presence of socio-economic inequity in hospital-based childbirth uptake in rural Tanzania and explored whether this relationship was modified by parity. This inequity may compound the burden of greater mortality among the poorest women and their babies. Records for 4456 rural women from the 2015–16 Tanzania Demographic and Health Survey with a live birth in the preceding 5 years were examined. Proportions of births at each location (home/PHC/hospital) were calculated by demographic and obstetric characteristics. Multinomial logistic regression was used to obtain crude and adjusted odds ratios of home/PHC and hospital/PHC births based on household wealth, including interaction between wealth and parity. Post-estimation margins analysis was applied to estimate childbirth location by wealth and parity. Hospital-based childbirth uptake was inequitable. The gap between poorest and richest was less pronounced at first birth. Hospital-based care utilization was lowest (around 10%) among the poorest multiparous women, with no increase at high parity (≥5) despite higher risk. PHC-based childbirth care was used by a consistent proportion of women after the first birth (range 30–51%). The poorest women utilized it at intermediate parity, but at parity ≥5 mostly gave birth at home. In an effort to provide effective childbirth care to all women, context-specific strategies are required to improve hospital-based care use, and poor, rural, high parity women are a particularly vulnerable group that requires specific attention. Improving childbirth care in PHC and strengthening referral linkages would benefit a considerable proportion of women.
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spelling pubmed-85058582021-10-13 Inequity in uptake of hospital-based childbirth care in rural Tanzania: analysis of the 2015–16 Tanzania Demographic and Health Survey Straneo, Manuela Benova, Lenka Hanson, Claudia Fogliati, Piera Pembe, Andrea B Smekens, Tom van den Akker, Thomas Health Policy Plan Original Article Proportions of facility births are increasing throughout sub-Saharan Africa, but obstetric services vary within the health system. In Tanzania, advanced management of childbirth complications (comprehensive emergency obstetric care) is offered in hospitals, while in frontline, primary health care (PHC) facilities (health centres and dispensaries) mostly only routine childbirth care is available. With over half (54%) of rural births in facilities, we hypothesized the presence of socio-economic inequity in hospital-based childbirth uptake in rural Tanzania and explored whether this relationship was modified by parity. This inequity may compound the burden of greater mortality among the poorest women and their babies. Records for 4456 rural women from the 2015–16 Tanzania Demographic and Health Survey with a live birth in the preceding 5 years were examined. Proportions of births at each location (home/PHC/hospital) were calculated by demographic and obstetric characteristics. Multinomial logistic regression was used to obtain crude and adjusted odds ratios of home/PHC and hospital/PHC births based on household wealth, including interaction between wealth and parity. Post-estimation margins analysis was applied to estimate childbirth location by wealth and parity. Hospital-based childbirth uptake was inequitable. The gap between poorest and richest was less pronounced at first birth. Hospital-based care utilization was lowest (around 10%) among the poorest multiparous women, with no increase at high parity (≥5) despite higher risk. PHC-based childbirth care was used by a consistent proportion of women after the first birth (range 30–51%). The poorest women utilized it at intermediate parity, but at parity ≥5 mostly gave birth at home. In an effort to provide effective childbirth care to all women, context-specific strategies are required to improve hospital-based care use, and poor, rural, high parity women are a particularly vulnerable group that requires specific attention. Improving childbirth care in PHC and strengthening referral linkages would benefit a considerable proportion of women. Oxford University Press 2021-07-19 /pmc/articles/PMC8505858/ /pubmed/34279643 http://dx.doi.org/10.1093/heapol/czab079 Text en © The Author(s) 2021. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Straneo, Manuela
Benova, Lenka
Hanson, Claudia
Fogliati, Piera
Pembe, Andrea B
Smekens, Tom
van den Akker, Thomas
Inequity in uptake of hospital-based childbirth care in rural Tanzania: analysis of the 2015–16 Tanzania Demographic and Health Survey
title Inequity in uptake of hospital-based childbirth care in rural Tanzania: analysis of the 2015–16 Tanzania Demographic and Health Survey
title_full Inequity in uptake of hospital-based childbirth care in rural Tanzania: analysis of the 2015–16 Tanzania Demographic and Health Survey
title_fullStr Inequity in uptake of hospital-based childbirth care in rural Tanzania: analysis of the 2015–16 Tanzania Demographic and Health Survey
title_full_unstemmed Inequity in uptake of hospital-based childbirth care in rural Tanzania: analysis of the 2015–16 Tanzania Demographic and Health Survey
title_short Inequity in uptake of hospital-based childbirth care in rural Tanzania: analysis of the 2015–16 Tanzania Demographic and Health Survey
title_sort inequity in uptake of hospital-based childbirth care in rural tanzania: analysis of the 2015–16 tanzania demographic and health survey
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8505858/
https://www.ncbi.nlm.nih.gov/pubmed/34279643
http://dx.doi.org/10.1093/heapol/czab079
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