Factors affecting home delivery among women living in remote areas of rural Zambia: a cross-sectional, mixed-methods analysis

Figures & data

Figure 1 Illustration of the MAHMAZ concurrent mixed-methods study design.

Abbreviations: ANC, antenatal care; PNC, postnatal care.

Figure 2 Distribution of households with village centers 10 km or more from the health facility catchment area.

Table 1 Characteristics of the study sample: household survey and in-depth interview respondents

Characteristics	Total household survey sample (n=2,381)		Total in-depth interview sample (n=240)
	N	%	N	%
Household characteristics
Household size – persons
Median (IQR)	6.0 (4.0–9.0)		7.0 (5.0–9.0)a
Dependency ratiob
Mean (SD)	1.5 (0.9)		1.5 (0.8)
Distance to health facility in catchment area (km)
Median (IQR)	12.8 (10.9–16.2)		12.8 (10.9–17.2)
Distance to health facility in catchment area (km)
9.5–9.9c	290	12.2	27	11.3
10–14.9	1,317	55.5	128	53.8
15–19.9	422	17.8	46	19.3
20–24.9	134	5.6	15	6.3
≥25	212	8.9	22	9.2
Housing characteristics
Non-improved water sourced	1,336	56.2	134	55.8
Non-improved toilete	2,140	89.9	197	82.0a
No electricity	2,368	99.7	239	100.0
House has earth or sand floors	2,094	88.1	200	83.3a
Charcoal or wood cooking fuel	2,368	99.5	239	99.6
Characteristics of recently delivered women
Woman’s age (years)
15–19	426	18.0	32	13.4
20–24	761	32.1	74	31.0
25–29	454	19.1	49	20.5
30–34	382	16.1	42	17.6
35 and older	349	14.7	42	17.6
Women’s age in years
Mean (SD)	26.1 (7.0)		27.0 (7.2)
Years of education
Mean (SD)	6.3 (2.3)		6.4 (2.2)
Highest level of education
No education	362	15.3	29	12.1
Some primary	968	40.8	90	37.5
Completed primary	476	20.1	65	27.1
Some secondary	532	22.4	50	20.8
Completed secondary	36	1.5	6	2.5
Religion
Catholic	286	12.1	34	14.2
Protestant	2,078	87.6	204	85.4
Other	9	0.4	1	0.4
Marital status
Never married	159	6.7	12	5.0
Married/cohabiting	2,092	88.1	216	90.0
Divorced/separated/widowed	125	5.3	12	5.0
Gravida
Mean (SD)	3.9 (2.5)		4.2 (2.5)a
Parity
Mean (SD)	3.6 (2.4)		3.9 (2.3)a
Antenatal care visits
None	14	0.6	0.0	0.0
1	71	3.0	4	1.7
2	217	9.1	17	7.1
3	680	28.6	75	31.3
≥4	1,392	58.6	144	60.0
Age of index infant, most recently delivered baby (months)
Mean (SD)	5.6	2.4	5.4	3.7
Delivery location of index infant
Home	364	15.3	48	20.1
Any health facility	1,934	81.4	184	77.0
En route to facility	77	3.2	7	2.9
Used MWH while awaiting delivery	701	29.6	82	34.6

Notes:

a Chi-squared or t-test significant at 0.05 level of significance.

b Sum of children <18 years of age and persons 65 years or older divided by the number of adults aged 18–64 years in the household.

c One village was located 8.3 km from the health facility but the households (n=11) from that village were located >9.5 km and were retained in the analysis.

d Non-improved water source: unprotected dug well, unprotected spring, tanker truck, cart with small tank, surface water.

e Non-improved toilet: pit latrine without slab/open pit, bucket toilet, hanging toilet/latrine, no facility/bush/field.

Abbreviations: IQR, interquartile range; MWH, maternity waiting home.

Table 2 Characteristics of recently delivered women living >10 km from the health facility by delivery location

Characteristics	Home delivery (n=364)		Any facility delivery (n=1,934)		En route to a facility (n=77)a		P-valueb
	N	%	N	%	N	%
Age in years							<0.001
15–19	38	10.5	378	19.6	8	10.4
20–24	113	31.2	624	32.4	22	28.6
25–29	68	18.8	371	19.3	13	16.9
30–34	72	19.9	291	15.1	19	24.7
≥35	71	19.6	263	13.7	15	19.5
Education							0.007
None	74	20.3	271	14.1	16	20.8
Any primary	220	60.4	1,174	60.9	46	59.7
More than primary	70	19.2	483	25.1	15	19.5
Marital status							0.310
Never married	26	7.1	130	6.7	3	3.9
Divorced/separated/widowed	24	6.6	99	5.1	1	1.3
Married/cohabitating	314	86.3	1,701	88.1	73	94.8
Wealth index quartile							0.238
1-lowest	85	25.1	436	24.2	26	36.6
2	93	27.4	455	25.2	12	16.9
3	81	23.9	460	25.5	14	19.7
4-highest	80	23.6	454	25.2	19	26.8
Parity							<0.001
0	0	0.0	6	0.3	0	0.0
1	46	12.6	491	25.4	12	15.6
2	65	17.9	372	19.2	10	13.0
3	57	15.7	239	12.4	11	14.3
4	43	11.8	224	11.6	12	15.6
≥5	153	42.0	601	31.1	32	41.6
Primigravida							<0.001
No	325	89.3	1,477	76.4	66	85.7
Yes	39	10.7	456	23.6	11	14.3
More than four ANC visits							<0.001
No	210	57.7	732	37.9	40	52.0
Yes	154	42.3	1,199	62.1	37	48.1
Distance to facility (km)
Median (IQR)	12.7 (11.0, 16.1)		12.7 (10.8, 16.3)		12.8 (11.3, 15.3)
Distance to facility (km)							0.163
9.5–9.9	39	10.7	243	12.6	6	7.8
10–14.9	217	59.6	1,045	54.2	51	66.2
15–19.9	67	18.4	347	18.0	8	10.4
20–24.9	20	5.5	107	5.6	7	9.1
≥25	21	5.8	186	9.7	5	6.5
Used MWH awaiting delivery							<0.001
No	350	96.4	1,204	64.4	76	98.7
Yes	13	3.6	687	35.7	1	1.3
Intended delivery location							<0.001
Home	13	3.6	7	0.4	1	1.3
Health facility	351	96.4	1,922	99.6	76	98.7
Questions only answered by women who reported delivering at a facility
Mode of transport
Walking	–	–	433	22.4	0	–
Bicycle	–	–	591	30.6	0	–
Animal cart/wheelbarrow	–	–	153	7.9	0	–
Car/taxi/bus	–	–	615	32.4	0	–
Motorcycle	–	–	103	5.3	0	–
Ambulance	–	–	24	1.2	0	–
Travel time (hours)
Median (IQR)	–	–	1.4 (0.8, 2.0)		0	–
Travel time (hours)
<1	–	–	490	25.6	0	–
1–2.9	–	–	987	51.5	0	–
3–4.9	–	–	335	17.5	0	–
≥5	–	–	105	5.5	0	–

Notes:

a Less than 1% had missing information on delivery location.

b P-values were calculated using a chi-squared test of association.

Abbreviations: IQR, interquartile range; MWH, maternity waiting home.

Table 3 Predictors of home delivery among recently delivered women living >10 km from the health facility

Variables	Delivered at home
	Crude OR (95% CI)	P-value	Adjusted ORa (95% CI)	P-value
Age in years
15–19	0.6 (0.4, 0.8)	0.006	0.7 (0.4, 1.2)	0.134
20–24	1.0		1.0
25–29	1.0 (0.7, 1.4)	0.940	0.9 (0.6, 1.3)	0.428
30–34	1.3 (0.9, 1.8)	0.094	1.1 (0.7, 1.6)	0.396
≥35	1.5 (1.0, 2.1)	0.032	1.3 (0.9, 1.9)	0.049
Education
None	1.4 (1.0, 1.9)	0.020	1.2 (0.9, 1.7)	0.074
Any primary	1.0		1.0
More than primary	0.8 (0.6, 1.1)	0.123	0.8 (0.6, 1.2)	0.123
Marital status
Never married	1.1 (0.7, 1.7)	0.675	2.1 (1.2, 3.7)	0.025
Divorced/separated or widowed	1.3 (0.8, 2.2)	0.255	1.2 (0.7, 2.1)	0.542
Married/cohabitating	1.0		1.0
Wealth index
1-lowest	0.9 (0.6, 1.3)	0.647	1.0 (0.7, 1.5)	0.145
2	1.0		1.0
3	0.8 (0.6, 1.2)	0.369	0.7 (0.5, 1.0)	0.164
4-highest	0.8 (0.6, 1.2)	0.337	0.7 (0.5, 1.1)	0.204
Primigravida
No	1.0		1.0
Yes	0.4 (0.3, 0.6)	<0.001	0.4 (0.2, 0.6)	<0.001
Four or more ANC visits
No	2.2 (1.7, 2.7)	<0.001	2.0 (1.5, 2.5)	<0.001
Yes	1.0		1.0
Distance to facility (km)
9.5–10	0.8 (0.5, 1.3)	0.331	0.7 (0.4, 1.1)	0.068
10–14.9	1.0		1.0
15–19.9	1.0 (0.6, 1.5)	0.826	1.1 (0.7, 1.7)	0.422
20–24.9	0.9 (0.5, 1.6)	0.696	1.4 (0.7, 2.8)	0.225
≥25	0.6 (0.3, 0.9)	0.020	0.8 (0.5, 1.4)	0.457
Stayed at maternity waiting home
No	1.0		1.0
Yes	0.1 (0.0, 0.1)	<0.001	0.1 (0.0, 0.1)	<0.001
SMGL
SMGL-exposed	1.0		1.0
SMGL-unexposed	3.1 (2.3, 4.1)	<0.001	3.2 (2.3, 4.5)	<0.001

Note:

a Predictors adjusted for in the model are displayed in the table.

Abbreviations: ANC, antenatal care; SMGL, Saving Mothers, Giving Life.