Abstract:
Introduction: A World Health Organization study conducted in 2016 revealed that
hospital delivery was a key determinant in reduction of maternal morbidity and
mortality. In Dedza District, Malawi, wide variation in proportion of hospital births
exist among health facilities implementing Conditional Cash Transfers (CCT) for
reimbursement of transport and hospital stay during childbirth to motivate women to
deliver in health facility.
Objectives: The study set out to identify socioeconomic and demographic
characteristics determining hospital utilization in CCT context; determine proportion
of hospital births attributed to CCT; explore perceptions of women towards
intrapartum care in the context of CCT; and explain factors influencing home
deliveries in the context of CCT.
Methods: A cross-sectional survey was conducted at eight health facilities providing
CCT to women for delivering in a health facility, with sample size of 369.
Participants were selected using systematic sampling and a structured questionnaire
was used to collect data from women attending Maternal Newborn and Child Health
services. Three Focus Group Discussions (FGD) were conducted among CCT
beneficiaries, none beneficiaries and those who delivered at home. Besides
descriptive statistics, Chi-square testand multiple logistic binary regression was
carried out.
Results: A total 338 (91.6%) delivered at hospital. From univariate analysis, age at
first pregnancy, number of antenatal care (ANC) visits and time of CCT awareness
were associated with hospital delivery (Crude P < 0.05). In multivariate regression
model, the odds of delivering at hospital for women who were aware of CCT program
early was 11.97 (p<0.001) and those who attended four or more ANC visits was 2.74.
Themes from FGDs reveal several barriers for hospital delivery, namely transport;
hospital stay cost and attitude of care providers. Majority (86.5%) of women were
satisfied with care in CCT facilities and were likely to return in future.
Conclusion: Significant factors determining hospital delivery were number of
antenatal visits and time of CCT program awareness. Cost of transport and hospital
stay, previous hospital experience and attitude of health care providers are described
by qualitative findings.
Recommendations: Encouraging early CCT program awareness, incentivizing
number of ANC visits, establishing mechanism allowing mother to travel to hospital
without incurring personal cost and health system to focus on improving attitude of
care providers are key measures for ensuring hospital delivery.
