Decentralizing Maternity Services to Increase Skilled Attendance at Birth and Antenatal Care Utilization in Rural Rwanda: A Prospective Cohort Study

Lisa M. Nathan, Quihu Shi, Kari Plewniak, Charles Zhang, Damien Nsabimana, Marc Sklar, Eugene Mutimura, Irwin R. Merkatz, Mark H. Einstein, Kathryn Anastos

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

To evaluate the effectiveness of decentralizing ambulatory reproductive and intrapartum services to increase rates of antenatal care (ANC) utilization and skilled attendance at birth (SAB) in Rwanda. A prospective cohort study was implemented with one control and two intervention sites: decentralized ambulatory reproductive healthcare and decentralized intrapartum care. Multivariate logistic regression analysis was performed with primary outcome of lack of SAB and secondary outcome of ≥3 ANC visits. 536 women were entered in the study. Distance lived from delivery site significantly predicted SAB (p = 0.007), however distance lived to ANC site did not predict ≥3 ANC visits (p = 0.81). Neither decentralization of ambulatory reproductive healthcare (p = 0.10) nor intrapartum care (p = 0.40) was significantly associated with SAB. The control site had the greatest percentage of women receive ≥3 ANC visits (p < 0.001). Receiving <3 ANC visits was associated with a 3.98 times greater odds of not having SAB (p = 0.001). No increase in adverse outcomes was found with decentralization of ambulatory reproductive health care or intrapartum care. The factors that predict utilization of physically accessible services in rural Africa are complex. Decentralization of services may be one strategy to increase rates of SAB and ANC utilization, but selection biases may have precluded accurate analysis. Efforts to increase ANC utilization may be a worthwhile investment to increase SAB.

Original languageEnglish (US)
Pages (from-to)1949-1955
Number of pages7
JournalMaternal and Child Health Journal
Volume19
Issue number9
DOIs
StatePublished - Sep 1 2015

Fingerprint

Rwanda
Prenatal Care
Cohort Studies
Parturition
Prospective Studies
Politics
Delivery of Health Care
Selection Bias
Reproductive Health
Logistic Models
Regression Analysis

Keywords

  • Decentralization
  • Global
  • Skilled birth attendance

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Epidemiology
  • Obstetrics and Gynecology
  • Pediatrics, Perinatology, and Child Health

Cite this

Decentralizing Maternity Services to Increase Skilled Attendance at Birth and Antenatal Care Utilization in Rural Rwanda : A Prospective Cohort Study. / Nathan, Lisa M.; Shi, Quihu; Plewniak, Kari; Zhang, Charles; Nsabimana, Damien; Sklar, Marc; Mutimura, Eugene; Merkatz, Irwin R.; Einstein, Mark H.; Anastos, Kathryn.

In: Maternal and Child Health Journal, Vol. 19, No. 9, 01.09.2015, p. 1949-1955.

Research output: Contribution to journalArticle

Nathan, Lisa M. ; Shi, Quihu ; Plewniak, Kari ; Zhang, Charles ; Nsabimana, Damien ; Sklar, Marc ; Mutimura, Eugene ; Merkatz, Irwin R. ; Einstein, Mark H. ; Anastos, Kathryn. / Decentralizing Maternity Services to Increase Skilled Attendance at Birth and Antenatal Care Utilization in Rural Rwanda : A Prospective Cohort Study. In: Maternal and Child Health Journal. 2015 ; Vol. 19, No. 9. pp. 1949-1955.
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