title: Socio-economic factors associated with maternal health-seeking behaviours among women from poor households in rural Egypt.
abstract: BACKGROUND
  Socio-economic inequalities in basic maternal health interventions exist in Egypt, yet little is known about health-seeking of poor households. This paper assesses levels of maternal health-seeking behaviours in women living in poor households in rural Upper Egypt, and compares these to national averages. Secondly, we construct innovative measures of socio-economic resourcefulness among the rural poor in order to examine the association between the resulting variables and the four dimensions of maternal health-seeking behaviour.
  
  
  METHODS
  We analysed a cross-sectional survey conducted in Assiut and Sohag governorates in 2010-2011 of 2,242 women in households below the poverty line in 65 poorest villages in Egypt. The associations between four latent socio-economic constructs (socio-cultural resourcefulness, economic resourcefulness, dwelling quality and woman's status) and receipt of any antenatal care (ANC), regular ANC (four or more visits), facility delivery and private sector delivery for women's most recent pregnancy in five years preceding survey were assessed using multivariate logistic regression.
  
  
  RESULTS
  In the sample, 58.5% of women reported using any ANC and 51.1% facility delivery, lower than national coverage (74.2% and 72.4%, respectively). The proportion of ANC users receiving regular ANC was lower (67%) than nationally (91%). Among women delivering in facilities, 18% of women in the poor Upper Egypt sample used private providers (63% nationally). In multivariate analysis, higher economic resourcefulness was associated with higher odds of receiving ANC but with lower odds of facility delivery. Socio-cultural resourcefulness was positively associated with receiving any ANC, regular ANC and facility delivery, whereas it was not associated with private delivery care. Dwelling quality was positively associated with private delivery facility use. Woman's status was not independently associated with any of the four behaviours.
  
  
  CONCLUSIONS
  Coverage of basic maternal health interventions and utilisation of private providers are lower among rural poor women in Upper Egypt than nationally. Variables capturing socio-cultural resourcefulness and economic resourcefulness were useful predictors of ANC and facility delivery. Further understanding of issues surrounding availability, affordability and quality of maternal health services among the poor is crucial to eliminating inequalities in maternal health coverage in Egypt.
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Lenka.Benova@lshtm.ac.uk.
authors.forename: Lenka
authors.initials: L
authors.lastname: Benova
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Oona.Campbell@lshtm.ac.uk.
authors.forename: Oona M R
authors.initials: OM
authors.lastname: Campbell
authors.affiliation: Social Research Center, American University in Cairo, Cairo, Egypt. HaniaS@aucegypt.edu.
authors.forename: Hania
authors.initials: H
authors.lastname: Sholkamy
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. G.Ploubidis@ioe.ac.uk.|Centre for Longitudinal Studies, Institute of Education, London, WC1H 0AL, UK. G.Ploubidis@ioe.ac.uk.
authors.forename: George B
authors.initials: GB
authors.lastname: Ploubidis
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004534:Egypt; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities; D006801:Humans; D016015:Logistic Models; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D011203:Poverty; D011247:Pregnancy; D011331:Private Practice / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D055815:Young Adult