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. 2009 Sep;99(9):1666-72.
doi: 10.2105/AJPH.2008.146209. Epub 2009 Jul 16.

Women's preferences for place of delivery in rural Tanzania: a population-based discrete choice experiment

Margaret E Kruk  1 , Magdalena Paczkowski, Godfrey Mbaruku, Helen de Pinho, Sandro Galea
Affiliations

Women's preferences for place of delivery in rural Tanzania: a population-based discrete choice experiment

Margaret E Kruk et al. Am J Public Health. 2009 Sep.

Abstract

Objectives: We fielded a population-based discrete choice experiment (DCE) in rural western Tanzania, where only one third of women deliver children in a health facility, to evaluate health-system factors that influence women's delivery decisions.

Methods: Women were shown choice cards that described 2 hypothetical health centers by means of 6 attributes (distance, cost, type of provider, attitude of provider, drugs and equipment, free transport). The women were then asked to indicate which of the 2 facilities they would prefer to use for a future delivery. We used a hierarchical Bayes procedure to estimate individual and mean utility parameters.

Results: A total of 1203 women completed the DCE. The model showed good predictive validity for actual facility choice. The most important facility attributes were a respectful provider attitude and availability of drugs and medical equipment. Policy simulations suggested that if these attributes were improved at existing facilities, the proportion of women preferring facility delivery would rise from 43% to 88%.

Conclusions: In regions in which attended delivery rates are low despite availability of primary care facilities, policy experiments should test the effect of targeted quality improvements on facility use.

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Figures

FIGURE 1
FIGURE 1
Sample discrete choice experiment card and script presented to women (N = 1203) from Kasulu District: Kigoma, Tanzania, 2007.
See this image and copyright information in PMC

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