Potential factors associated with institutional childbirth among women in rural villages of Lao People's Democratic Republic: a preliminary study

Abstract

Background: The provision of quality health services has been a global priority to reduce neonatal and maternal deaths. In Lao People's Democratic Republic (Lao PDR), the coverage of institutional childbirth stayed at a low level regardless of a sharp increase in the coverage of antenatal care (ANC) and fee exemption. The aim of the present study was to preliminary explore factors associated with increased institutional childbirth and the association between ANC attendance and maternal knowledge among women in rural villages of Lao PDR.

Methods: A secondary data analysis was conducted using data collected through a pilot survey in Sekong province in Lao PDR. The study participants were women with children under 5 years of age in villages within 10 km (km) from health centers staffed with skilled birth attendants. Data were collected via a face-to-face interview using a semi-structured questionnaire and were analysed using logistic regression models to estimate odds ratios (ORs) and their 95% confidence intervals (CIs) for having institutional childbirth in relation to potential factors.

Results: A total of 302 women, 203 (67.2%) of whom gave birth at a health facility. 277 (91.7%) attended ANC at least once. Sixty-nine women (22.9%) had received no formal education, 272 (90.1%) were of an ethnic minority, 174 (57.6%) were unwaged and 99 (32.8%) lived more than 6 km from the nearest health facility. 51 (16.6%) did not know about birth complications at interview. Institutional childbirth was negatively associated with a lack of maternal knowledge about birth complications (OR, 0.27; 95% Cl, 0.14-0.54) after adjusting for covariates. Although there were few women who did not received ANC, the results suggested ANC might not be associated with maternal knowledge about birth complications (OR, 1.87; 95% Cl, 0.43-8.12).

Conclusions: The present study suggests that maternal knowledge about birth complications is an important factor in increasing the institutional childbirth in rural villages of Lao PDR where majority of residents were ethnic minority. Improving quality of ANC and attitude among health care providers may be key to increasing health-seeking behavior. However, further research is needed to understand factors influencing choice of place of childbirth.

Keywords: Health education; Institutional childbirth; Lao PDR; Maternal knowledge; Quality of antenatal care; Rural village; Skilled birth attendant.