title: Accessibility and utilisation of delivery care within a Skilled Care Initiative in rural Burkina Faso.
abstract: OBJECTIVE
  The Skilled Care Initiative (SCI) was a comprehensive skilled attendance at delivery strategy implemented by the Ministry of Health and Family Care International in Ouargaye district (Burkina Faso) from 2002 to 2005. We aimed to evaluate the relationships between accessibility, functioning of health centres and utilisation of delivery care in the SCI intervention district (Ouargaye) and compare this with another district (Diapaga).
  
  
  METHODS
  Data were collected on staffing, equipment, water and energy supply for all health centres and a functionality index for health centres were constructed. A household census was carried out in 2006 to assess assets of all household members, and document pregnancies lasting more than 6 months between 2001 and 2005, with place of delivery and delivery attendant. Utilisation of delivery care was defined as birth in a health institution or birth by Caesarean section. Analyses included univariate and multivariate logistic regression.
  
  
  RESULTS
  Distance to health facility, education and asset ownership were major determinants of delivery care utilisation, but no association was found between the functioning of health centres (as measured by infrastructure, energy supply and equipment) and institutional birth rates or births by Caesarean section. The proportion of births in an institution increased more substantially in the SCI district over time but no changes were seen in Caesarean section rates.
  
  
  CONCLUSIONS
  The SCI has increased uptake of institutional deliveries but there is little evidence that it has increased access to emergency obstetric care, at least in terms of uptake of Caesarean sections. Its success is contingent on large-scale coverage and 24-h availability of referral for life saving drugs, skilled personnel and surgery for pregnant women.
authors.affiliation: Immpact, Centre Muraz, Bobo-Dioulasso, Burkina Faso.
authors.forename: Sennen
authors.initials: S
authors.lastname: Hounton
authors.forename: Glyn
authors.initials: G
authors.lastname: Chapman
authors.forename: Joris
authors.initials: J
authors.lastname: Menten
authors.forename: Vincent
authors.initials: V
authors.lastname: De Brouwere
authors.forename: Tim
authors.initials: T
authors.lastname: Ensor
authors.forename: Issiaka
authors.initials: I
authors.lastname: Sombié
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meda
authors.forename: Carine
authors.initials: C
authors.lastname: Ronsmans
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D002648:Child; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008427:Maternal Health Services / Q000706:statistics & numerical data* / Q000600:supply & distribution; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D019035:Rural Health Services / Q000592:standards*; D055815:Young Adult