title: Factors associated with utilization of motorcycle ambulances by pregnant women in rural eastern Uganda: a cross-sectional study.
abstract: BACKGROUND
  Evidence suggests that use of motorcycle ambulances can help to improve health facility deliveries; however, few studies have explored the motivators for and barriers to their usage. We explored the factors associated with utilization of motorcycle ambulances by pregnant women in eastern Uganda.
  
  
  METHODS
  This was a cross-sectional, mixed-methods study conducted among 391 women who delivered at four health facilities supplied with motorcycle ambulances in Mbale district, eastern Uganda, between April and May 2014. Quantitative data were collected on socio-demographic and economic characteristics, pregnancy and delivery history, and community and health facility factors associated with utilization of motorcycle ambulances using semi-structured questionnaires. Qualitative data were collected on the knowledge and attitudes towards using motorcycle ambulances by pregnant women through six focus group discussions. Using STATA v.12, we computed the characteristics of women using motorcycle ambulances and used a logistic regression model to assess the correlates of utilization of motorcycle ambulances. Qualitative data were analyzed manually using a master sheet analysis tool.
  
  
  RESULTS
  Of the 391 women, 189 (48.3%) reported that they had ever utilized motorcycle ambulances. Of these, 94.7% were currently married or living together with a partner while 50.8% earned less than 50,000 Uganda shillings (US $20) per month. Factors independently associated with use of motorcycle ambulances were: older age of the mother (≥35 years vs ≤24 years; adjusted Odds Ratio (aOR) = 4.3, 95% CI: 2.03, 9.13), sharing a birth plan with the husband (aOR = 2.5, 95% CI: 1.19, 5.26), husband participating in the decision to use the ambulance (aOR =3.22, 95% CI: 1.92, 5.38), and having discussed the use of the ambulance with a traditional birth attendant (TBA) before using it (aOR =3.12, 95% CI: 1.88, 5.19). Qualitative findings indicated that community members were aware of what motorcycle ambulances were meant for and appreciated their role in taking pregnant women to health facilities.
  
  
  CONCLUSIONS
  The use of motorcycle ambulances was associated with older age of the mother, male participation in birth preparedness, and consultations with TBAs. These findings suggest a need for interventions to involve men in reproductive health as well as efforts to reach women younger than 35 years of age.
authors.affiliation: Makerere University College of Health Sciences, School of Public Health, P.O. Box 7072, Kampala, Uganda. ssebunyarogers@gmail.com.
authors.forename: Rogers
authors.initials: R
authors.lastname: Ssebunya
authors.affiliation: Makerere University College of Health Sciences, School of Public Health, P.O. Box 7072, Kampala, Uganda.
authors.forename: Joseph K B
authors.initials: JKB
authors.lastname: Matovu
mesh_terms: D000293:Adolescent; D000328:Adult; D000552:Ambulances / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008423:Maternal Age; D008880:Midwifery / Q000706:statistics & numerical data; D009049:Motorcycles / Q000706:statistics & numerical data*; D016017:Odds Ratio; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D011295:Prenatal Care / Q000706:statistics & numerical data; D036301:Qualitative Research; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D018454:Spouses / Q000523:psychology; D014454:Uganda; D055815:Young Adult