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. 2021 Sep 10;21(1):948.
doi: 10.1186/s12913-021-06973-5.

Mobility for maternal health among women in hard-to-reach fishing communities on Lake Victoria, Uganda; a community-based cross-sectional survey

Ali Ssetaala  1   2 , Julius Ssempiira  3 , Gertrude Nanyonjo  4 , Brenda Okech  4 , Kundai Chinyenze  5 , Bernard Bagaya  3 , Matt A Price  5   6 , Noah Kiwanuka  3 , Olivier Degomme  7
Affiliations

Mobility for maternal health among women in hard-to-reach fishing communities on Lake Victoria, Uganda; a community-based cross-sectional survey

Ali Ssetaala et al. BMC Health Serv Res. .

Abstract

Background: Maternal mortality is still a challenge in Uganda, at 336 deaths per 100,000 live births, especially in rural hard to reach communities. Distance to a health facility influences maternal deaths. We explored women's mobility for maternal health, distances travelled for antenatal care (ANC) and childbirth among hard-to-reach Lake Victoria islands fishing communities (FCs) of Kalangala district, Uganda.

Methods: A cross sectional survey among 450 consenting women aged 15-49 years, with a prior childbirth was conducted in 6 islands FCs, during January-May 2018. Data was collected on socio-demographics, ANC, birth attendance, and distances travelled from residence to ANC or childbirth during the most recent childbirth. Regression modeling was used to determine factors associated with over 5 km travel distance and mobility for childbirth.

Results: The majority of women were residing in communities with a government (public) health facility [84.2 %, (379/450)]. Most ANC was at facilities within 5 km distance [72 %, (157/218)], while most women had travelled outside their communities for childbirth [58.9 %, (265/450)]. The longest distance travelled was 257.5 km for ANC and 426 km for childbirth attendance. Travel of over 5 km for childbirth was associated with adolescent girls and young women (AGYW) [AOR = 1.9, 95 % CI (1.1-3.6)], up to five years residency duration [AOR = 1.8, 95 % CI (1.0-3.3)], and absence of a public health facility in the community [AOR = 6.1, 95 % CI (1.4-27.1)]. Women who had stayed in the communities for up to 5 years [AOR = 3.0, 95 % CI (1.3-6.7)], those whose partners had completed at least eight years of formal education [AOR = 2.2, 95 % CI (1.0-4.7)], and those with up to one lifetime birth [AOR = 6.0, 95 % CI (2.0-18.1)] were likely to have moved to away from their communities for childbirth.

Conclusions: Despite most women who attended ANC doing so within their communities, we observed that majority chose to give birth outside their communities. Longer travel distances were more likely among AGYW, among shorter term community residents and where public health facilities were absent.

Trial registration: PACTR201903906459874 (Retrospectively registered). https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5977 .

Keywords: Childbirth; Communities; Distance; Fishing; Island; Mobility; Uganda; Women.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Locations of health facilities where the women received ANC.
Fig. 2
Fig. 2
Locations of health facilities where the women had childbirths.
See this image and copyright information in PMC

References

    1. Uganda Bureau of Statistics (UBOS), ICF. Uganda Demographic and Health Survey 2016: Key Indicators Report [Internet]. Kampala, Uganda: UBOS, and Rockville, Maryland, USA.; 2017 [cited 2021 Aug 28]. Available from: https://dhsprogram.com/pubs/pdf/FR333/FR333.pdf
    1. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. The Lancet Global Health. 2017 Jan 26;2(6):e323–33. - PubMed
    1. Véronique Filippi, Doris Chou, Carine Ronsmans, Wendy Graham, Lale Say. Levels and causes of maternal mortality and morbidity. In: Disease Control Priorities, Third Edition (Volume 2): Reproductive, Maternal, Newborn, and Child Health [Internet]. The World Bank; 2016. p. 51–70. (Disease Control Priorities). Available from: 10.1596/978-1-4648-0348-2_ch3
    1. World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience [Internet]. Geneva, Switzerland: World Health Organization; 2016 [cited 2017 Jan 26]. 152. Available from: http://www.who.int/nutrition/publications/guidelines/antenatalcare-pregn... - PubMed
    1. World Health Organization, UNICEF, United Nations Population Fund, The World Bank. Trends in maternal mortality: 2000 to 2017 [Internet]. Geneva; 2019. Available from: https://data.unicef.org/resources/trends-maternal-mortality-2000-2017/

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