Factors associated with home delivery in Kaoma Central Constituency of Kaoma District
Simbuwa, Ireen L.N.Amukena.
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Objective: The main objective of the study was to determine factors associated with home delivery among women delivering in Kaoma central constituency.Design: It was a case control study involving 248 women with children less than 6 months old who delivered in Kaoma central constituency of Kaoma District. 124 were women who delivered from home who were called cases and the other 124 were women who delivered in health facilities we called controls. The study was conducted from January 2003 to November 2003. Setting: The study setting was Kaoma central constituency where 4 out of 7 constituencies were visited under the limitation of mobility. Shikombwe ward of Luampa constituency was also included in the study due to the proximity to Mulamatila ward and similarity of the life style and resource sharing of the two groups of people. A stratified random sampling method was used to select the respondents.The main outcome: The main out come was the place of delivery. The results of the study were based on the interviews with mothers on the history of their previous labour, regarding their age. marital status, educational level, socio- economic status, distance from the nearest health facility, antenatal care visits, number of last pregnancy, birth order and birth preparedness.Due to the limitation of lack of the prevalence of the exposure variables of interest among the cases and the controls, sample size determination was done after recruiting 30 cases and 30 controls into the study. The analysis for sample size calculation was based on 5% significance level. Finally since two analyses were done after completion of the study, a result of considered significant if it yielded a p-value of less than 0.025 Results: On bivariate analyses, there was no association between age and place of delivery (p=0.258) and between marital status and place of delivery (p=694). The proportion of women with no education or only primary education was significantly higher (p<0.001) among the cases than the controls. Unemployment was also significantly higher (p<0.002) among the cases than the controls. Equally unemployment was also significantly higher (p=0.009) among husbands to the cases than the controls.The proportion of respondents who lived within less than 1 hour walking distance to the nearest health facility was significantly higher (p<0.001) among the controls than the cases. Despite this there was no statistical difference (p=0.339) in the nearest health facility between the two groups. No association was observed between the number of the last pregnancy and the place of delivery (p-0.147) and birth order and place of delivery (p=0.32l). There was also no association between antenatal care visits and place of delivery (p=0.387) and between staff attitude and place of delivery (p=0.545).The majority of both the cases (62.1%) and controls (43.5%) made their own decision on their place of delivery. Still on bivariate analysis, the use of traditional medicine to fasten labour was significantly higher (p<0.001) among cases than controls. Knowledge of availability of a TBA was also significantly higher (p<0.00l) among cases than controls. Common taboos were that very few people should enter the delivery room and that a person who has just has sexual intercourse should not assist a delivery. The majority of the cases 26.4% suggested to build health centres nearby and the majority of the controls 51.3% suggested to build a better maternity ward.On multivariate analysis after adjusting for confounding variables, those who with no education or with only primary education were 89% more likely to deliver at home and that those who lived within less than 1 hour walking distance to the nearest health facility and were 78% less likely to be cases.Conclusion: An association existed between educational level and place of delivery and between distance to the nearest health facility and place of delivery.Recommendations: Based on these findings, we recommend that, intensive Information, Education and Communication (lEC) should be carried out in most simpler terms (such as drama and discussions) to give information on the benefits of a health facility delivery. We also recommend that a study be conducted to verify why women who live within less than 1 hour walking distance to the nearest health centre and deliver from health facilities are 78% less likely to be cases.