title: Factors associated with delivery outside a health facility: cross-sectional study in rural Malawi.
abstract: OBJECTIVE
  To identify factors associated with delivery outside a health facility in rural Malawi.
  
  
  METHODS
  A cross-sectional survey was conducted in Balaka, Dedza, Mchinji and Ntcheu districts in Malawi in 2013 among women who had completed a pregnancy 12 months prior to the day of the survey. Multilevel logistic regression was used to assess factors associated with delivery outside a facility.
  
  
  RESULTS
  Of the 1812 study respondents, 9% (n = 159) reported to have delivered outside a facility. Unmarried women were significantly more likely [OR = 1.88; 95% CI (1.086-3.173)] to deliver outside a facility, while women from households with higher socio-economic status [third-quartile OR = 0.51; 95% CI (0.28-0.95) and fourth-quartile OR = 0.48; 95% CI (0.29-0.79)] and in urban areas [OR = 0.39; 95%-CI (0.23-0.67)] were significantly less likely to deliver outside a facility. Women without formal education [OR 1.43; 95% CI (0.96-2.14)] and multigravidae [OR = 1.14; 95% CI (0.98-1.73)] were more likely to deliver outside a health facility at 10% level of significance.
  
  
  CONCLUSIONS
  About 9% of women deliver outside a facility. Policies to encourage facility delivery should not only focus on health systems but also be multisectoral to address women's vulnerability and inequality. Facility-based delivery can contribute to curbing the high maternal illness burden if authorities provide incentives to those not delivering at the facility without losing existing users.
authors: Institute of Public Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany.|School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
authors: Jacob
authors: J
authors: Mazalale
authors: Institute of Public Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany.|School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
authors: Christabel
authors: C
authors: Kambala
authors: Institute of Public Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany.
authors: Stephan
authors: S
authors: Brenner
authors: School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.|Centre for International Health, University of Bergen, Bergen, Norway.
authors: Jobiba
authors: J
authors: Chinkhumba
authors: Institute of Public Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany.
authors: Julia
authors: J
authors: Lohmann
authors: School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
authors: Don P
authors: DP
authors: Mathanga
authors: Centre for International Health, University of Bergen, Bergen, Norway.
authors: Bjarne
authors: B
authors: Robberstad
authors: School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
authors: Adamson S
authors: AS
authors: Muula
authors: Institute of Public Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany.
authors: Manuela
authors: M
authors: De Allegri
keywords: Afrique subsaharienne; Malawi; accouchement dans un établissement; accoucheuses qualifiées; cuidados maternos: parto intrahospitalario; facility-based delivery; maternal care; partera cualificada; santé maternelle; skilled birth attendance; sub-Saharan Africa; África subsahariana
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