Determinants of Maternal Health Care Services Utilization in Sierra Leone between 2009 And 2013

Abstract

BACKGROUND: Sierra Leone has one of the worst maternal health indices among other countries, and it is also one of the countries with the lowest human development index. Majority of the causes of maternal morbidity and mortality can be prevented by means of utilization of adequate antenatal care, institutional delivery and skilled birth attendants. However, utilization of Maternal Health Care (MHC) services is generally low in the country. There is an alarming shortage of skilled Health Care Workers (HCW) and limited number of Health Care Facilities (HCF). OBJECTIVE: To identify the factors that influenced the utilization of MCH Services during the five years period preceding the 2013 Sierra Leone Demographic and Health Survey (SLDHS). METHOD: Data on the most recent pregnancy during the five years period preceding the 2013 Demographic and Health Surveys (DHS) were used. Outcome measures were Antenatal Care and Delivery Care. Chi square test and Logistic regression models were used to determine the relationships between key socio-demographic factors and outcome measures.Antenatal Care Almost all pregnant women (94%) in Sierra Leone received antenatal care (ANC) from skilled providers (doctor, nurse, midwife, or MCH aide) during the five years period preceding the 2013 SLDHS; most commonly from a nurse/midwife (58%), followed by MCH Aide (34%). The government health facilities were the commonest place of ANC for the majority (95%) of the pregnant women. Almost all of the women (98%) made at least one ANC visit, whilst 89% made four (4) or more visits during their pregnancy. About 93% of women took iron tablets or syrup during pregnancy and 89% of the women were informed about signs of pregnancy complications during ANC visit. Ninety five percent of women’s most recent births were protected against neonatal tetanus whilst only 75% took antimalarial prophylaxis. Place of residence, age and religion of the respondents were found to be significant determinants of ANC services utilization during the five years period preceding the 2013 SLDHS. Almost all (99%) of the women in the urban area had ANC at a health facility compared to those in the rural area (98%).Delivery Care Only about 59% of deliveries occur in health facilities; mainly in government health facilities (57%). More than 2 in 5 births occur at home. Nearly 6 in 10 deliveries were assisted by skilled providers.Women whose marital status was described as separated/divorced/widowed were more likely to give birth in a health facility. Those women who practice traditional/other religion were less likely to give birth in a health facility. Similarly, women who had ANC and also those from households with high wealth index were most likely to have their births attended by a skilled provider. CONCLUSIONS: The utilization of Delivery Care services by the women was low, despite the high utilization of the ANC services. Home delivery is still a serious problem in Sierra Leone because a greater proportion of the women gave birth in homes in the hands of unskilled birth attendants. The utilization of MHC services was influenced by several socio-demographic characteristics of the women such as Age, Region, Religion, Household Wealth Index, Marital Status, Place of Residence and Parity