Community and health system factors associated with facility delivery in rural Tanzania: a multilevel analysis.
OBJECTIVE
Tanzania, a country with high maternal mortality, has many primary health facilities yet has a low rate of facility deliveries. This study estimated the contribution of individual and community factors in explaining variation in the use of health facilities for childbirth in rural Tanzania.


METHODS
A two-stage cluster population-based survey was conducted in Kasulu District, western Tanzania with women with a recent delivery. Random intercept multilevel logistic regression models were used to assess the association between individual- and village-level factors and likelihood of facility delivery.


RESULTS
1205 women participated in the study. In the fully adjusted two-level model, in addition to several individual factors, positive village perception of doctor and nurse skills (odds ratio (OR) 6.72, 95% confidence interval (CI): 2.47-18.31) and negative perception of traditional birth attendant skills (OR 0.13, 95% CI: 0.04-0.40) were associated with higher odds of facility delivery.


CONCLUSIONS
This study suggests that community perceptions of the quality of the local health system influence women's decisions to deliver in a clinic. Improving quality of care at first-level clinics and communicating this to communities may assist efforts to increase facility delivery in sub-Saharan Africa.
Columbia University Mailman School of Public Health, Department of Health Policy and Management, 600 W. 168th Street, New York, NY 10032, USA. mkruk@columbia.edu
Margaret E
ME
Kruk
Peter C
PC
Rockers
Godfrey
G
Mbaruku
Magdalena M
MM
Paczkowski
Sandro
S
Galea
D000328:Adult; D016550:Birthing Centers / Q000706:statistics & numerical data*; D003696:Delivery Rooms / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D016013:Likelihood Functions; D016015:Logistic Models; D008429:Maternal Welfare; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011787:Quality of Health Care; D013636:Tanzania