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Home >> Publications >> Decentralizing Maternity Services to Increase Skilled Attendance at Birth and Antenatal Care Utilization in Rural Rwanda: A Prospective Cohort Study.

Publication

Author(s):

Nathan LM1, Shi Q, Plewniak K, Zhang C, Nsabimana D, Sklar M, Mutimura E, Merkatz IR, Einstein MH, Anastos K.

Pub Title:

Decentralizing Maternity Services to Increase Skilled Attendance at Birth and Antenatal Care Utilization in Rural Rwanda: A Prospective Cohort Study.

Pub Date:

Feb 5 2015

Pub Region(s):

Central Africa

Journal Issue:

Epub

Page Number:
Epub

Journal:

Title: 
Maternal and Child Health Journal
Link: 
http://link.springer.com/article/10.1007%2Fs10995-015-1702-5

PubMed: 25652061
Pub PDF:

To evaluate the effectiveness of decentralizing ambulatory reproductive and intrapartum services to increase rates of antenatal care (ANC) utilization and skilled attendance at birth (SAB) in Rwanda. A prospective cohort study was implemented with one control and two intervention sites: decentralized ambulatory reproductive healthcare and decentralized intrapartum care. Multivariate logistic regression analysis was performed with primary outcome of lack of SAB and secondary outcome of ≥3 ANC visits. 536 women were entered in the study. Distance lived from delivery site significantly predicted SAB (p = 0.007), however distance lived to ANC site did not predict ≥3 ANC visits (p = 0.81). Neither decentralization of ambulatory reproductive healthcare (p = 0.10) nor intrapartum care (p = 0.40) was significantly associated with SAB. The control site had the greatest percentage of women receive ≥3 ANC visits (p < 0.001). Receiving <3 ANC visits was associated with a 3.98 times greater odds of not having SAB (p = 0.001). No increase in adverse outcomes was found with decentralization of ambulatory reproductive health care or intrapartum care. The factors that predict utilization of physically accessible services in rural Africa are complex. Decentralization of services may be one strategy to increase rates of SAB and ANC utilization, but selection biases may have precluded accurate analysis. Efforts to increase ANC utilization may be a worthwhile investment to increase SAB.

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Citation:

Nathan LM, Shi Q, Plewniak K, Zhang C, Nsabimana D, Sklar M, Mutimura E, Merkatz IR, Einstein MH, Anastos K. Decentralizing Maternity Services to Increase Skilled Attendance at Birth and Antenatal Care Utilization in Rural Rwanda: A Prospective Cohort Study. Matern Child Health J. 2015 Feb 5. [Epub ahead of print] PubMed PMID: 25652061.