Use pattern of maternal health services and determinants of skilled care during delivery in Southern Tanzania: implications for achievement of MDG-5 targets.
BACKGROUND
Almost two decades since the initiation of the Safe motherhood Initiative, Maternal Mortality is still soaring high in most developing countries. In 2000 WHO estimated a life time risk of a maternal death of 1 in 16 in Sub- Saharan Africa while it was only 1 in 2800 in developed countries. This huge discrepancy in the rate of maternal deaths is due to differences in access and use of maternal health care services. It is known that having a skilled attendant at every delivery can lead to marked reductions in maternal mortality. For this reason, the proportion of births attended by skilled health personnel is one of the indicators used to monitor progress towards the achievement of the MDG-5 of improving maternal health.


METHODS
Cross sectional study which employed quantitative research methods.


RESULTS
We interviewed 974 women who gave birth within one year prior to the survey. Although almost all (99.8%) attended ANC at least once during their last pregnancy, only 46.7% reported to deliver in a health facility and only 44.5% were assisted during delivery by a skilled attendant. Distance to the health facility (OR = 4.09 (2.72-6.16)), discussion with the male partner on place of delivery (OR = 2.37(1.75-3.22)), advise to deliver in a health facility during ANC (OR = 1.43 (1.25-2.63)) and knowledge of pregnancy risk factors (OR 2.95 (1.65-5.25)) showed significant association with use of skilled care at delivery even after controlling for confounding factors.


CONCLUSIONS
Use of skilled care during delivery in this district is below the target set by ICPD + of attaining 80% of deliveries attended by skilled personnel by 2005. We recommend the following in order to increase the pace towards achieving the MDG targets: to improve coverage of health facilities, raising awareness for both men and women on danger signs during pregnancy/delivery and strengthening counseling on facility delivery and individual birth preparedness.
Mpembeni
Rose Nm
RN
School of Public Health and Social Sciences, Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar-Es-Salaam, Tanzania. rcmpembeni@yahoo.com
Killewo
Japhet Z
JZ
Leshabari
Melkzedeck T
MT
Massawe
Siriel N
SN
Jahn
Albrecht
A
Mushi
Declare
D
Mwakipa
Hassan
H
D000328:Adult; D002983:Clinical Competence; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000458:organization & administration; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration*; D008429:Maternal Welfare / Q000706:statistics & numerical data*; D008880:Midwifery / Q000458:organization & administration*; D009723:Nurse-Patient Relations; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000451:nursing; D011787:Quality of Health Care; D013636:Tanzania / Q000453:epidemiology