Assessing delivery practices of mothers over time and over space in Uganda, 2003–2012
Abstract Background It is well known that safe delivery in a health facility reduces the risks of maternal and infant mortality resulting from perinatal complications. What is less understood are the factors associated with safe delivery practices. We investigate factors influencing health facility...
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| Format: | Article |
| Language: | English |
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BMC
2016-06-01
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| Series: | Emerging Themes in Epidemiology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12982-016-0049-8 |
| _version_ | 1811228826181566464 |
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| author | Daniel A. Sprague Caroline Jeffery Nadine Crossland Thomas House Gareth O. Roberts William Vargas Joseph Ouma Stephen K. Lwanga Joseph J. Valadez |
| author_facet | Daniel A. Sprague Caroline Jeffery Nadine Crossland Thomas House Gareth O. Roberts William Vargas Joseph Ouma Stephen K. Lwanga Joseph J. Valadez |
| author_sort | Daniel A. Sprague |
| collection | DOAJ |
| description | Abstract Background It is well known that safe delivery in a health facility reduces the risks of maternal and infant mortality resulting from perinatal complications. What is less understood are the factors associated with safe delivery practices. We investigate factors influencing health facility delivery practices while adjusting for multiple other factors simultaneously, spatial heterogeneity, and trends over time. Methods We fitted a logistic regression model to Lot Quality Assurance Sampling (LQAS) data from Uganda in a framework that considered individual-level covariates, geographical features, and variations over five time points. We accounted for all two-covariate interactions and all three-covariate interactions for which two of the covariates already had a significant interaction, were able to quantify uncertainty in outputs using computationally intensive cluster bootstrap methods, and displayed outputs using a geographical information system. Finally, we investigated what information could be predicted about districts at future time-points, before the next LQAS survey is carried out. To do this, we applied the model to project a confidence interval for the district level coverage of health facility delivery at future time points, by using the lower and upper end values of known demographics to construct a confidence range for the prediction and define priority groups. Results We show that ease of access, maternal age and education are strongly associated with delivery in a health facility; after accounting for this, there remains a significant trend towards greater uptake over time. We use this model together with known demographics to formulate a nascent early warning system that identifies candidate districts expected to have low prevalence of facility-based delivery in the immediate future. Conclusions Our results support the hypothesis that increased development, particularly related to education and access to health facilities, will act to increase facility-based deliveries, a factor associated with reducing perinatal associated mortality. We provide a statistical method for using inexpensive and routinely collected monitoring and evaluation data to answer complex epidemiology and public health questions in a resource-poor setting. We produced a model based on this data that explained the spatial distribution of facility-based delivery in Uganda. Finally, we used this model to make a prediction about the future priority of districts that was validated by monitoring and evaluation data collected in the next year. |
| first_indexed | 2024-04-12T10:02:50Z |
| format | Article |
| id | doaj.art-3d4a2ac42a5149cc809c2621538f7b16 |
| institution | Directory Open Access Journal |
| issn | 1742-7622 |
| language | English |
| last_indexed | 2024-04-12T10:02:50Z |
| publishDate | 2016-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Emerging Themes in Epidemiology |
| spelling | doaj.art-3d4a2ac42a5149cc809c2621538f7b162022-12-22T03:37:30ZengBMCEmerging Themes in Epidemiology1742-76222016-06-0113111210.1186/s12982-016-0049-8Assessing delivery practices of mothers over time and over space in Uganda, 2003–2012Daniel A. Sprague0Caroline Jeffery1Nadine Crossland2Thomas House3Gareth O. Roberts4William Vargas5Joseph Ouma6Stephen K. Lwanga7Joseph J. Valadez8Centre for Complexity Science, University of WarwickMETRe Group, Department of International Health, Liverpool School of Tropical MedicineMETRe Group, Department of International Health, Liverpool School of Tropical MedicineSchool of Mathematics, University of ManchesterStatistics Department, University of WarwickMETRe Group, Department of International Health, Liverpool School of Tropical MedicineManagement Sciences for HealthManagement Sciences for HealthMETRe Group, Department of International Health, Liverpool School of Tropical MedicineAbstract Background It is well known that safe delivery in a health facility reduces the risks of maternal and infant mortality resulting from perinatal complications. What is less understood are the factors associated with safe delivery practices. We investigate factors influencing health facility delivery practices while adjusting for multiple other factors simultaneously, spatial heterogeneity, and trends over time. Methods We fitted a logistic regression model to Lot Quality Assurance Sampling (LQAS) data from Uganda in a framework that considered individual-level covariates, geographical features, and variations over five time points. We accounted for all two-covariate interactions and all three-covariate interactions for which two of the covariates already had a significant interaction, were able to quantify uncertainty in outputs using computationally intensive cluster bootstrap methods, and displayed outputs using a geographical information system. Finally, we investigated what information could be predicted about districts at future time-points, before the next LQAS survey is carried out. To do this, we applied the model to project a confidence interval for the district level coverage of health facility delivery at future time points, by using the lower and upper end values of known demographics to construct a confidence range for the prediction and define priority groups. Results We show that ease of access, maternal age and education are strongly associated with delivery in a health facility; after accounting for this, there remains a significant trend towards greater uptake over time. We use this model together with known demographics to formulate a nascent early warning system that identifies candidate districts expected to have low prevalence of facility-based delivery in the immediate future. Conclusions Our results support the hypothesis that increased development, particularly related to education and access to health facilities, will act to increase facility-based deliveries, a factor associated with reducing perinatal associated mortality. We provide a statistical method for using inexpensive and routinely collected monitoring and evaluation data to answer complex epidemiology and public health questions in a resource-poor setting. We produced a model based on this data that explained the spatial distribution of facility-based delivery in Uganda. Finally, we used this model to make a prediction about the future priority of districts that was validated by monitoring and evaluation data collected in the next year.http://link.springer.com/article/10.1186/s12982-016-0049-8SurveyFacility-based deliveryLQASUgandaSpatial modellingEase of access |
| spellingShingle | Daniel A. Sprague Caroline Jeffery Nadine Crossland Thomas House Gareth O. Roberts William Vargas Joseph Ouma Stephen K. Lwanga Joseph J. Valadez Assessing delivery practices of mothers over time and over space in Uganda, 2003–2012 Emerging Themes in Epidemiology Survey Facility-based delivery LQAS Uganda Spatial modelling Ease of access |
| title | Assessing delivery practices of mothers over time and over space in Uganda, 2003–2012 |
| title_full | Assessing delivery practices of mothers over time and over space in Uganda, 2003–2012 |
| title_fullStr | Assessing delivery practices of mothers over time and over space in Uganda, 2003–2012 |
| title_full_unstemmed | Assessing delivery practices of mothers over time and over space in Uganda, 2003–2012 |
| title_short | Assessing delivery practices of mothers over time and over space in Uganda, 2003–2012 |
| title_sort | assessing delivery practices of mothers over time and over space in uganda 2003 2012 |
| topic | Survey Facility-based delivery LQAS Uganda Spatial modelling Ease of access |
| url | http://link.springer.com/article/10.1186/s12982-016-0049-8 |
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