Prevalence and factors associated with Skilled Birth Attendants use among post-partum women in Arusha Tanzania

Introduction Death related to pregnancy complications and delivery remains a public health problem in developing countries including Tanzania where majority of women and newborns die each year due to preventable causes. Delivery with a skilled birth attendant (SBA) is an important intervention to avert maternal and newborn mortality. This study aimed to determine factors influencing skilled birth attendant’s use among postpartum women in Arusha city and Arumeru district in Arusha region. Methods This was a cross-sectional study which was conducted from April to July 2017. The study utilized secondary data from the parent study which was conducted in Arusha city and Arumeru district in Arusha region. The parent study aimed to assess knowledge of danger signs in obstetric complication, birth preparedness and utilization of skilled birth attendants among post-partum women in urban and rural Arusha region in Tanzania. Data analysis was performed using SPSS version 20. Chi square statistics was used to determine the association between a set of independent variables and utilization of skilled birth attendance in bivariate analysis. Odds ratios with 95% confidence interval for factors influencing skilled birth attendants’ use were estimated in a multivariable logistic regression models. A p-value of less than 0.05 was considered statistically significant. Results A total of 1218 post-partum women were studied. Their mean age was 26.2 (SD 5.9) years. Of these, 1020 used skilled birth attendants during delivery; this corresponds to prevalence of 83.7%. Mother’s education level, area of residence, distance from health facility, frequency of antenatal care and parity were significantly associated utilization of skilled birth attendants during delivery. Conclusion The prevalence of skilled birth attendants’ use among postpartum women is high in the studied population compared to the national level. Strategies to create community awareness on important of skilled birth attendants’ use will increase its uptake and my help to reduce both mother and child mortality.


54
Globally, the maternal mortality ratio is estimated to be 261 maternal deaths per 100,000 live 55 births with majority (99%) of these deaths occurring in developing countries especially sub 56 Saharan Africa, where 66% of the maternal deaths occur 1 . This shows that women in the 57 developing countries continue to lose their lives due to preventable causes of pregnancy and 58 delivery complications. The WHO has made a call to reduce global mortality rate to less than 70 59 per 100,000 live births by 2030 2 . Furthermore a supplementary national target was made that no 60 country should have a maternal mortality more than twice the global average by 2030 3 . Access to 61 skilled birth attendants (SBA) during delivery can make the difference between life and death of  Globally, the proportion of deliveries attended by SBA increased from 59% to 71%, yet 73 this leaves more than one in four babies and mothers without access to this crucial medical care 74 during child birth 7 . As a result, maternal and newborn survival rate still remains low. There 75 exists a variation in SBA coverage, it is much lower (52%) in southern Asia and sub-Saharan Africa 7 . This variation makes the maternal morbidity and mortality rate to remain comparatively 77 high in developing countries including Tanzania. The current SBA coverage in Tanzania is 78 64% 8 . This is slightly lower than the global average.

79
In Tanzania under the national road map strategic plan to improve reproductive, maternal, 80 new born, child and adolescent health, the ministry of health has set target to increase coverage 81 of deliveries attended by skilled birth attends from 51% to 80% by 2020 by putting more 82 emphasis in the provision of quality health services offered by skilled attendants in enabling 83 environment 9 . In order to achieve this target, more emphasis should be done to identify and 84 eradicate the barriers which make expectant mothers not to access SBAs or make them to prefer 85 home delivery. The aim of this study was to determine factors affecting SBA use among 86 postpartum women in Arusha city and Arumeru districts.

88
Study design and data source

89
This was a cross-sectional study which was conducted from April to July 2017. The study 90 utilized secondary data from the parent study which was conducted in Arusha city and Arumeru  The purpose of the parent study was to assess knowledge of danger signs in obstetric 104

105
The parent study was carried out in two districts; Arusha city and Arumeru district of Arusha       This study has found education status to be significantly associated with SBA utilization 206 such that, women with higher education have higher tendency of SBA use. Similar findings were 207 previously reported in Tanzania 14,15 and India 16 . These findings show that attainment of higher 208 education, helps women to become more aware of pregnancy associated risks and consequences; 209 hence they tend to seek proper health care through SBA during delivery as compared with 210 uneducated women who may have limited access to information.

211
Distance from the health facility was associated with skilled birth attendant use during 212 delivery. This finding is similar to a study done in Nepal which showed that women who walk 213 for more than an hour to a health facility with delivery services are less likely to use SBA during 214 delivery 17 . This is also similar to a study done in Uganda 11 . Living less than an hour away from 215 the hospital guarantees short time taken by the mother to reach the facility when labour starts and 216 a lower transport cost. This motivates facility delivery under a skilled birth attendant.
In the present study ANC frequency was associated with SBA use during delivery such 218 that women who had more than 4 visits were more likely to deliver with SBA.