|Effect of maternal age on facility-based delivery: analysis of first-order births in 34 countries of sub-Saharan Africa using demographic and health survey data|
||Dunlop CL, Benova L, and Campbell O
||BMJ Open, 8(4):e020231. doi: 10.1136/bmjopen-2017-020231
Multiple African Countries
Increasing access to skilled birth attendance, usually via childbirth in health facilities, is a key intervention to reduce maternal and perinatal mortality and morbidity. Yet, in some countries of sub-Saharan Africa, the uptake is <50%. Age and parity are determinants of facility-based delivery, but are strongly correlated in high fertility settings. This analysis assessed the independent effect of age on facility-based delivery by restricting to first-order births. It was hypothesised that older first-time mothers in this setting might have lower uptake of facility-based deliveries than women in the most common age groups for first birth.
The most recent Demographic and Health Surveys from 34 sub-Saharan African countries were used to assess women's delivery locations.
72?772 women having their first birth in the 5?years preceding the surveys were included in the analysis.
PRIMARY AND SECONDARY OUTCOME MEASURES:
Proportions and 95%?CIs of facility-based deliveries were estimated overall and by country. Multivariable logistic regression was used to calculate the odds of facility-based delivery for different maternal age groups (15-19, 20-24 and =25 years) for a pooled sample of all countries.
59.9% of women had a facility-based delivery for their first birth (95%?CI 58.6 to 61.2), ranging from 19.4% in Chad to 96.6% in Rwanda. Compared with women aged 15-19 years, the adjusted odds of having a facility-based delivery for those aged 20-24 was 1.4 (95% CI 1.3 to 1.5, p<0.001) and for those aged =25, 1.9 (95% CI 1.6 to 2.2, p<0.001).
Older age at first birth was independently associated with significantly higher odds of facility-based delivery. This went against the hypothesis. Further mixed-method research is needed to explore how increased age improves uptake of facility-based delivery. Promoting facility-based delivery, while ensuring quality of care, should be prioritised to improve birth outcomes in sub-Saharan Africa.
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Africa South of the Sahara; delivery; demographic and health surveys; health facilities; maternal age; obstetric