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Assessing delivery practices of mothers over time and over space in Uganda, 2003-2012.

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Sprague, Daniel A, Jeffery, Caroline ORCID: https://orcid.org/0000-0002-8023-0708, Crossland, Nadine, House, Thomas, Roberts, Gareth O, Vargas, William, Ouma, Joseph, Lwanga, Stephen K and Valadez, Joseph ORCID: https://orcid.org/0000-0002-6575-6592 (2016) 'Assessing delivery practices of mothers over time and over space in Uganda, 2003-2012.'. Emerging themes in epidemiology, Vol 13, Issue 9.

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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.

Item Type: Article
Subjects: W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care
WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
WA Public Health > Statistics. Surveys > WA 900 Public health statistics
WQ Obstetrics > Obstetric Surgical Procedures > WQ 415 Delivery (including preparatory manipulation)
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1186/s12982-016-0049-8
Depositing User: Jessica Jones
Date Deposited: 20 Jun 2016 09:03
Last Modified: 06 Sep 2019 11:29
URI: https://archive.lstmed.ac.uk/id/eprint/5938

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