Barriers and facilitators for institutional delivery among poor Mesoamerican women: a cross-sectional study.

Autor:	Hernandez B; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., Colombara DV; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., Gagnier MC; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., Desai SS; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., Haakenstad A; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA and., Johanns C; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., McNellan CR; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., Nelson J; Salud Mesoamerica Initiative/Inter-American Development Bank, Panama, Panama., Palmisano EB; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., Ríos-Zertuche D; Salud Mesoamerica Initiative/Inter-American Development Bank, Panama, Panama., Schaefer A; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., Zúñiga-Brenes P; Salud Mesoamerica Initiative/Inter-American Development Bank, Panama, Panama., Iriarte E; Salud Mesoamerica Initiative/Inter-American Development Bank, Panama, Panama., Mokdad AH; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Jazyk:	angličtina
Zdroj:	Health policy and planning [Health Policy Plan] 2017 Jul 01; Vol. 32 (6), pp. 769-780.
DOI:	10.1093/heapol/czx010
Abstrakt:	Professional skilled care has shown to be one of the most promising strategies to reduce maternal mortality, and in-facility deliveries are a cost-effective way to ensure safe births. Countries in Mesoamerica have emphasized in-facility delivery care by professionally skilled attendants, but access to good-quality delivery care is still lacking for many women. We examined the characteristics of women who had a delivery in a health facility and determinants of the decision to bypass a closer facility and travel to a distant one. We used baseline information from the Salud Mesoamerica Initiative (SMI). Data were collected from a large household and facilities sample in the poorest quintile of the population in Guatemala, Honduras and Nicaragua. The analysis included 1592 deliveries. After controlling for characteristics of women and health facilities, being primiparous (RR = 1.15, 95% CI 1.10, 1.21), being literate (RR = 1.24, 95% CI 1.04, 1.48), having antenatal care (RR = 1.68, 95% CI 1.24, 2.27), being informed of the need for having a C-section (RR = 1.07, 95% CI 1.02, 1.11) and travel time to the closest facility totaling 1-2 h vs under 30 min (RR = 0.88, 95% CI 0.77, 0.99) were associated with in-health facility deliveries. In Guatemala, increased availability of medications and equipment at a distant facility was strongly associated with bypassing the closest facility in favor of a distant one for delivery (RR = 2.10, 95% CI 1.08, 4.07). Our study showed a strong correlation between well-equipped facilities and delivery attendance in poor areas of Mesoamerica. Indeed, women were more likely to travel to more distant facilities if the facilities were of higher level, which scored higher on our capacity score. Our findings call for improving the capacity of health facilities, quality of care and addressing cultural and accessibility barriers to increase institutional delivery among the poor population in Mesoamerica. (© The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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