Research Article: The Influence of Distance and Level of Care on Delivery Place in Rural Zambia: A Study of Linked National Data in a Geographic Information System

Date Published: January 25, 2011

Publisher: Public Library of Science

Author(s): Sabine Gabrysch, Simon Cousens, Jonathan Cox, Oona M. R. Campbell, Jennifer Bryce

Abstract: Using linked national data in a geographic information system system, Sabine Gabrysch and colleagues investigate the effects of distance to care and level of care on women’s use of health facilities for delivery in rural Zambia.

Partial Text: Maternal and perinatal mortality rates are still alarmingly high, especially in sub-Saharan Africa, where little progress has been made over recent decades [1]. Globally, an estimated 225,000 maternal deaths, 904,000 neonatal deaths, and 1.02 million stillbirths annually are intrapartum related [2]. Most of these deaths occur in low-income countries and could be avoided if all women delivered in a setting where skilled attendants can provide emergency obstetric care (EmOC) and life-saving neonatal interventions in the event of complications [2]–[4]. Yet every year 50 million women give birth at home without skilled care [5].

Ethical approval of this study was granted by the London School of Hygiene & Tropical Medicine ethics committee on 03 July 2007 (application number 5172).

Of the 3,692 births to rural mothers in the DHS 2007 with relevant distance information, 32.5% occurred in a health facility, 0.4% were home deliveries attended by a nurse or midwife, and 67.1% were neither in a facility nor attended professionally.

Linking national health facility data with national household survey data in a geographic information system allowed us to redress the lack of adequate data that has so far hampered detailed epidemiological studies on how characteristics of the health services influence use of delivery services [6],[9],[12],[25]. We quantified the strong influence of the health service environment on women’s use of health facilities for delivery in rural Zambia, while adjusting for other important determinants on the individual, household, and community level.



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