Rethinking How to Promote Maternity Care-Seeking: Factors Associated With Institutional Delivery in Guinea

Figures & data

FIGURE 1 Conceptual model of causal pathway between intervention exposure, intermediate outcomes, and behavioral outcomes.

TABLE 1 Participant Characteristics (N = 763)

Characteristic	Mean	Standard deviation
Age (in years)	28.2	7.4
Age at time of most recent birth (in years)	27.3	7.4
Wealth quintile	3.0	1.4
Parity	3.9	2.3
Characteristic	Number	Percent (%)
Region
Kissidougou	401	52.6
Labé	362	47.4
Religion
Muslim	620	81.3
Christian	143	18.7
Any education	243	31.8
Literacy (can read with difficulty or easily)	157	20.6
Currently married	719	94.2
Wealth quintile
Poorest	161	21.1
Second poorest	153	20.1
Middle	147	19.3
Fourth poorest	161	21.1
Least poor	139	18.2
Employed in remunerated activity	468	61.4
Member of community group	418	54.8
Ever travelled outside village	187	24.5
Live within 2 km of maternity care facility	366	48.0
Live more than 5 km of maternity care facility	169	22.1
Live within 30 minutes of maternity care facility	315	41.3
BP/CR Counseling Index (High)	309	44.8
Community Exposure Index (High)	304	39.8
Complication Readiness (CR) Knowledge Index (High)	108	14.2
Birth Preparedness (BP) Knowledge Index (High)	237	31.1
Birth Preparedness Behavioral Index (High)	262	34.3
At least one ANC visit	616	80.7
At least four ANC visits	434	57.0
Delivered in a health facility	396	51.9

TABLE 2 Bivariate Associations of Sociodemographic, Individual, and Intervention Factors With BP and CR Knowledge

	BP knowledge (high) N = 763		CR knowledge (high) N = 763
Characteristic	N (%)	OR (95% CI)	N (%)	OR (95% CI)
Age (≥ 25 years)	160 (0.9)	1. 1 (0.8, 1.5)	76 (10.0)	1.3 (0.8, 1.9)
Literacy	45 (5.9)	1.7 (1.1, 2.5)*	14 (1.8)	0.9 (0.5, 1.6)
Parity (≥ 2)	207 (27.1)	1.4 (0.9, 2.3)	91(11.9)	1.0 (0.6, 1.8)
Wealth (wealthiest two quintiles)	77 (10.1)	0.7 (0.5, 0.9)**	27 (3.5)	0.5 (0.3, 0.7)**
Distance to health facility ≤ 2 km	115 (15.1)	1.0 (0.7, 1.3)	47 (6.2)	0.7 (0.5, 1.1)
At least 1 ANC visit	186 (24.4)	1.0 (1.0, 1.0)	95 (12.4)	0.4 (0.0, 4.1)
At least 4 ANC visits	145 (19.0)	1.3 (1.0, 1.8) p =.09	62 (8.1)	1.0 (0.7, 1.5)
BP/CR Counseling Index (High)	120 (15.7)	2.0 (1.4, 2.7)***	62 (8.1)	2.4 (1.5, 3.7)***
Community Exposure Index (High)	130 (17.0)	2.5 (1.8, 3.4)***	56 (7.3)	1.8 (1.2, 2.7)**

*p ≤.05; **p ≤.01; ***p ≤.001.

TABLE 3 Bivariate Associations of Sociodemographic, Individual, Intervention, and Intermediate Outcome Variables With Birth Preparedness and Institutional Delivery

	Birth preparedness (high) N = 763		Institutional delivery N = 763
Characteristic	N (%)	OR (95% CI)	N (%)	OR (95% CI)
Age (≥ 25 years)	176 (23.1)	1.1 (0.8, 1.5)	257 (33.7)	0.9 (0.7, 1.2)
Literacy	44 (5.7)	1.4 (0.9, 2.2)	111 (14.5)	2.7 (1.9, 4.0)***
Parity (≥ 2)	223 (29.2)	1.1 (0.7, 1.7)	326 (42.7)	0.8 (0.5, 1.1)
Wealth (wealthiest two quintiles)	107 (14.0)	1.1 (0.5, 1.6)	185 (24.2)	1.9 (1.4, 2.6)***
Distance to health facility ≤ 2 km	131 (17.2)	1.1 (0.8, 1.6)	234 (30.7)	2.8 (2.1, 3.8)***
At least 1 ANC visit	211 (27.7)	1.0 (0.9, 1.0)	309 (40.4)	1.0 (0.9, 1.0)
At least 4 ANC visits	166 (21.8)	1.7 (1.2, 2.3)**	243 (31.8)	1.5 (1.1, 1.9) **
BP/CR Counseling Index (High)	159 (20.8)	4.7 (3.3, 6.6)***	196 (25.7)	2.4 (1.7, 3.2)***
Community Exposure Index (High)	134 (17.6)	2.0 (1.5, 2.8)***	170 (22.3)	1.3 (1.0, 1.8) p =.07
CR Knowledge Index (High)	45 (5.9)	1.4 (0.9, 2.1)	61 (8.0)	1.2 (0.8, 1.9)
BP Knowledge Index (High)	126 (16.5)	3.0 (2.2, 4.2)***	145 (19.0)	1.7 (1.3, 2.4)**
BP Behavioral Index (High)	—	—	184 (24.1)	3.6 (2.6, 5.0)***

*p ≤.05; **p ≤.01; ***p ≤.001.

TABLE 4 Multivariate Regression Results—Factors Associated With Increased Birth Preparedness

Variables (reference category)	Model 1 adjusted OR (95% CI)	Model 2 adjusted OR (95% CI)
Intervention exposure variables
BP/CR Counseling Index (high vs. low score)	4.3 (3.0, 6.1)***	4.0 (2.8, 5.8)***
Community Exposure Index (high vs. low score)	1.6 (1.1, 2.3)*	1.4 (1.0, 2.0)
ANC use (≥ 4 ANC visits during pregnancy vs. < 4 ANC visits)	1.6 (1.1, 2.3)*	1.6 (1.1, 2.3)*
Intermediate outcome variables
BP Knowledge Index (high vs. low score)	—	2.2 (1.5, 3.2)***

*p ≤.05; **p ≤.01; ***p ≤.001.

TABLE 5 Multivariate Regression Results: Factors Associated With Institutional Delivery

Variables (reference category)	Model 1 adjusted OR (95% CI)	Model 2 adjusted OR (95% CI)
Intervention exposure variables
BP Counseling Index (high vs. low score)	2.3 (1.6, 3.2)***	1.8 (1.2, 2.6)**
Community Exposure Index (high vs. low score)	1.3 (0.9, 1.9)	1.1 (0.8, 1.7)
Sociodemographic & individual variables
Wealth (two wealthiest quintiles vs. three poorest quintiles)	1.9 (1.3, 2.7)**	2.0 (1.4, 3.0)**
Literacy (able to read easily or with difficulty vs. cannot read at all)	2.4 (1.5, 4.1)**	2.4 (1.4, 4.3)**
Distance (≤ 2 km of maternity care vs. > 2 km)	2.6 (1.8, 3.6)***	2.7 (1.9, 3.9)***
ANC use (≥ 4 ANC visits during pregnancy vs. < 4 ANC visits)	1.4 (1.0, 1.9)	1.3 (0.9, 1.8)
Intermediate outcome variables
BP Knowledge Index (high vs. low score)	—	1.3 (0.9, 2.0)
BP Behavioral Index (high vs. low score)	—	2.5 (1.7, 3.8)***

*p ≤.05; **p ≤.01; ***p ≤.001.