Authors : Leroy S. Maximore, Abdul Gafaru Mohammed, Gyesi Razak Issahaku, Samuel Sackey, Ernest Kenu
Site of publication: BMC Pregnancy and Childbirth
Type of publication: research article
Date of publication: August 2022
Background
In developing countries, a large proportion of mothers still deliver at home compared to developed countries[68.7% as against 1.3%]. In Liberia, home delivery continues to be relatively high compared to developed countries, 44% and 20% in 2013 and 2019 respectively. While Liberia has embraced the World Health Organization’s policy of prohibiting deliveries at home, 56% of the deliveries in rural communities are undertaken at home, of which Margibi county contributes a significant amount. In Margibi County, health facility delivery is less than 80%, with an estimated over 85% of maternal mortality attributed to home delivery. Infant mortality and under-five mortality rate in the County have been estimated at 65 per 1000 and 111 per 1000 live births respectively.
Study area
The county has 62 health facilities, of which two are Hospitals, 14 Health Centers and 46 Clinics. Twenty-four of the 62 health facilities are government-owned. The county has one government referral hospital located in the Kakata district which has the majority of the skilled and qualified public health workforce. The Margibi County Health Team manages the county’s health sector with technical and financial support from the central Ministry of Health and partners. The county has two functional ambulances for the referral of cases from one level to another. The county transport system is accessible only in urban communities, while rural communities are difficult to reach.
Factors associated with home delivery, in Margibi County, Liberia
The district of residence, age, marital status, religion, gravida, parity, season/period in the year, type of setting, the onset of labor, education, male health worker and transport to health facility at the time of delivery were selected for a multivariable logistic regression at P < 0.2. From these factors, the age, attitude of health workers, parity, availability of transport to health facility at the time of delivery and onset of labor were significantly associated with home delivery in the county.
Discussion
Pregnant women’s choice of place of delivery is usually an important decision at the final stage of their gestational period. Some of these pregnant women deliver at home, whereas some go to the health facility. Despite the numerous interventions by the WHO and programmes implemented by various governments of Liberia, home delivery remains one of the significant challenges the country faces. The current study revealed that more than 90% of the women studied delivered at home in their most recent delivery in Margibi County.
The factors associated with home delivery among pregnant women in the county were age, parity, the attitude of health workers, the onset of labor and availability of transport. Women who had given birth more than once were more likely to deliver at home compared to women who gave birth for the first time.
This finding is similar to the findings of other studies done in Southwest Ethiopia, Trincomalee, Sri Lanka and Nepal. This might be because women who have given birth several times perceive themselves to be more experienced in labor, thereby developing more interest in using home delivery services. The attitude of health workers towards clients who access health care services is instrumental to the care-seeking participation rate. Pregnant women who perceive health workers to be of good attitude were more likely to deliver at a health facility.
Conclusion
The prevalence of home delivery in the county was over 90%. Women more than 31 years, multiparous women, and rapid onset of labor were significantly associated with increased odds of home delivery. the availability of transport and the good attitude of health workers were associated with reduced odds of home delivery. At a policy level, we recommend that the MOH conduct in-service training for healthcare providers on positive attitudes towards patients. the Government of Liberia should make available ambulance vehicles in all county districts and provide incentives for health facility delivery.