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Individual and community level factors associated with health facility delivery: A cross sectional multilevel analysis in Bangladesh

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  • Tanvir M Huda
  • Morseda Chowdhury
  • Shams El Arifeen
  • Michael J Dibley

Abstract

Introduction: Improving maternal health remains one of the targets of sustainable development goals. A maternal death can occur at any time during pregnancy, but delivery is by far the most dangerous time for both the woman and her baby. Delivery at a health facility can avoid most maternal deaths occurring from preventable obstetric complications. The influence of both individual and community factors is critical to the use of health facility delivery services. In this study, we aim to examine the role of individual and community factors associated with health facility-based delivery in Bangladesh. Methods: This cross-sectional study used data from the Bangladesh Maternal Mortality Survey. The sample size constitutes of 28,032 women who had delivered within five years preceding the survey. We fitted logistic random effects regression models with the community as a random effect to assess the influence of individual and community level factors on use of health facility delivery services. Results: Our study observed substantial amount of variation at the community level. About 28.6% of the total variance in health facility delivery could be attributed to the differences across the community. At community level, place of residence (AOR 1.48; 95% CI 1.35–1.64), concentration of poverty (AOR 1.15; 95% CI 1.03–1.28), concentration of use of antenatal care services (AOR 1.11, 95% CI 1.00–1.23), concentration of media exposure (AOR 1.20, 95% CI 1.07–1.34) and concentration of educated women (AOR 1.12, 95% CI 1.02–1.23) were found to be significantly associated with health facility delivery. At individual level, maternal age, educational status of the mother, religion, parity, delivery complications, individual exposure to media, individual access to antenatal care and household socioeconomic status showed strong association with health facility-based delivery. Conclusion: Our results strongly suggest factors at both Individual, and community level influenced the use of health facility delivery services in Bangladesh. Thus, any future strategy to improve maternal health in Bangladesh must consider community contexts and undertake multi-sectorial approach to address barriers at different levels. At the individual level the programs should also focus on the need of the young mother, the multiparous the less educated and women in the poorest households.

Suggested Citation

  • Tanvir M Huda & Morseda Chowdhury & Shams El Arifeen & Michael J Dibley, 2019. "Individual and community level factors associated with health facility delivery: A cross sectional multilevel analysis in Bangladesh," PLOS ONE, Public Library of Science, vol. 14(2), pages 1-13, February.
    • Handle: RePEc:plo:pone00:0211113
    DOI: 10.1371/journal.pone.0211113
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    1. Tesfaye Regassa Feyissa & Gebi Agero Genemo, 2014. "Determinants of Institutional Delivery among Childbearing Age Women in Western Ethiopia, 2013: Unmatched Case Control Study," PLOS ONE, Public Library of Science, vol. 9(5), pages 1-7, May.
    2. Markos Mezmur & Kannan Navaneetham & Gobopamang Letamo & Hadgu Bariagaber, 2017. "Individual, household and contextual factors associated with skilled delivery care in Ethiopia: Evidence from Ethiopian demographic and health surveys," PLOS ONE, Public Library of Science, vol. 12(9), pages 1-16, September.
    3. Kruk, Margaret E. & Rockers, Peter C. & Mbaruku, Godfrey & Paczkowski, Magdalena M. & Galea, Sandro, 2010. "Community and health system factors associated with facility delivery in rural Tanzania: A multilevel analysis," Health Policy, Elsevier, vol. 97(2-3), pages 209-216, October.
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    6. Mamunur Rashid & Mohammad Rocky Khan Chowdhury & Manzur Kader & Anne-Sofie Hiswåls & Gloria Macassa, 2022. "Determinants of Utilization of Institutional Delivery Services in Zambia: An Analytical Cross-Sectional Study," IJERPH, MDPI, vol. 19(5), pages 1-13, March.
    7. Felix Akpojene Ogbo & Felicity F. Trinh & Kedir Y. Ahmed & Praween Senanayake & Abdon G. Rwabilimbo & Noel E. Uwaibi & Kingsley E. Agho & Global Maternal and Child Health Research Collaboration (GloMA, 2020. "Prevalence, Trends, and Drivers of the Utilization of Unskilled Birth Attendants during Democratic Governance in Nigeria from 1999 to 2018," IJERPH, MDPI, vol. 17(1), pages 1-26, January.
    8. Yan Xu & Michael Yao-Ping Peng & Rolle Remi Ahuru & Muhammad Khalid Anser & Romanus Osabohien & Ayesha Aziz, 2022. "Individual and community-level factors associated with non-institutional delivery of women of childbearing-age in Nigeria," Palgrave Communications, Palgrave Macmillan, vol. 9(1), pages 1-7, December.

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