title: Female migrants, family members and community socio-demographic characteristics influence facility delivery in Rufiji, Tanzania.
abstract: BACKGROUND
  Health professionals and public health experts in maternal and newborn health encourage women to deliver at health facilities in an effort to reduce maternal and newborn mortality. In the existing literature, there is scant information on how migration, family members and community influence facility delivery. This study addresses this knowledge gap using 10 years of longitudinal surveillance data from a rural district of Tanzania.
  
  
  METHODS
  Multilevel logistic regression was used to quantify the influence of hypothesized migration, family and community-level factors on facility delivery while adjusting for known confounders identified in the literature. We report adjusted odds ratios (AOR).
  
  
  RESULTS
  Overall, there has been an increase of 14% in facility delivery over the ten years, from 63% in 2001 to 77% in 2010 (p < .001). Women residing in households with female migrants from outside their community were more likely to give birth in a facility AOR = 1.2 (95% CI 1.11-1.29). Furthermore, the previous facility delivery of sisters and sisters-in-law has a significant influence on women's facility delivery; AOR = 1.29, 95% CI 1.15-1.45 and AOR = 1.7, 95% CI 1.35-2.13 respectively. Community level characteristics play a role as well; women in communities with higher socioeconomic status and older women of reproductive age had increased odds of facility delivery; AOR = 2.37, 95% CI 1.88-2.98 and AOR = 1.17, 95% CI 1.03-1.32 respectively.
  
  
  CONCLUSIONS
  Although there has been an increase in facility delivery over the last decade in Rufiji, this study underscores the importance of female migrants, family members and community in influencing women's place of delivery. The findings of this study suggest that future interventions designed to increase facility delivery must integrate person-to-person facility delivery promotion, especially through women of the community and within families. Furthermore, the results suggest that investment in formal education of the community and increased community socio-economic status may increase facility delivery.
authors.affiliation: Data Analysis Cluster Unit, Ifakara Health Institute, Plot 463, Kiko Avenue Mikocheni, PO Box 78373, Dar es Salaam, Tanzania. flevira@ihi.or.tz.
authors.forename: Francis
authors.initials: F
authors.lastname: Levira
authors.forename: Lauren
authors.initials: L
authors.lastname: Gaydosh
authors.forename: Astha
authors.initials: A
authors.lastname: Ramaiya
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D004522:Educational Status; D005191:Family Characteristics; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D012111:Residence Characteristics; D035781:Siblings; D012923:Social Class; D013636:Tanzania; D014171:Transients and Migrants; D055815:Young Adult