title: Prevalence and predictors of institutional delivery among pregnant mothers in Biharamulo district, Tanzania: a cross-sectional study.
abstract: BACKGROUND
  Giving birth in a health facility is associated with lower maternal mortality than giving birth at home. A recent Tanzania Demographic Health survey showed that, although more than 90% of pregnant women attended at least one antenatal clinic visit, only 50% of pregnant women delivered at a health facility. The aim of this study was to document the magnitude and predictors of institutional delivery in order to assist in setting priorities and developing appropriate intervention measures to reduce maternal mortality.
  
  
  METHODS
  We conducted a cross-sectional study of women in Biharamulo district who delivered during the year preceding the survey. Multistage sampling was used to obtain 598 participants. A structured questionnaire was used to collect data. Bivariate and multivariate analysis was performed.
  
  
  RESULTS
  56% of women delivered in a health facility. Factors most strongly associated with institutional delivery were past care experience (aOR=265.1, 95%CI 28.6-2466.7), advice from health care provider to deliver at a health care facility (aOR=29.2, 95%CI 2.9-291.5), decision making on health care seeking on a pregnancy (aOR=7.1, 95%CI 2.7-19.0), maternal education (aOR=6.7, 95%CI 2.3-20.0), first antenatal care visit at <16 weeks (aOR=2.4, 95%CI 1.0-5.1), stable maternal income (aOR=2.3, 95%CI (1.1-4.7), and distance to facility<5 km (aOR 2.3 (95%CI 1.3-3.9).
  
  
  CONCLUSIONS
  The prevalence of institutional delivery in Biharamulo District remains low. To raise the prevalence, the district should implement measures to make institutional delivery the preferred option for pregnant women. These measures should include encouraging women to make early antenatal care visits and make plans with their spouses for institutional delivery, reducing costs, improving the experience for women undergoing delivering in a healthcare facility, and consider locating new facilities closer to the women who need them.
authors.affiliation: Biharamulo District Council, Department of Health, Biharamulo, Kagera, Tanzania.
authors.forename: Kihulya
authors.initials: K
authors.lastname: Mageda
authors.affiliation: Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.
authors.forename: Elia John
authors.initials: EJ
authors.lastname: Mmbaga
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003657:Decision Making; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data*; D006700:Home Childbirth / Q000706:statistics & numerical data*; D006801:Humans; D008428:Maternal Mortality; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D015995:Prevalence; D011795:Surveys and Questionnaires; D013636:Tanzania; D055815:Young Adult
keywords: Institution delivery; antenatal care services; home delivery