Bypassing or Successful Referral? A Population-Based Study of Reasons Why Women Travel Far for Childbirth in Eastern Uganda

Paul Mubiri, Makerere University School of Public Health
Darious Kajjo, Makerere University School of Public Health
Monica Okuga, Makerere University School of Public Health
Tanya Marchant, London School of Hygiene & Tropical Medicine, London
Stefan Peterson, Uppsala University
Peter Waiswa, Makerere University School of Public Health
Claudia Hanson, Health Systems and Policy | Global Public Health | Karolinska Institutet

Abstract Background: Delivery in a facility with a skilled health provider is considered the most important intervention to reduce maternal and early newborn deaths. The aim of this study was to investigate to what extent mothers in rural Uganda bypassed their nearest facility for childbirth. Methods: Multilevel logistic regression was used to model the relationship between bypassing the nearest health facility for childbirth and the different independent factors. Results: Of all women delivering in a health facility, 29% (204/717) of women bypassed their nearest facility to give birth in another facility. The odds of bypassing increased if a mother belonged to the highest wealth quintile (AOR 2.24) and decreased with an increase in the readiness score of the nearest facility for childbirth (AOR=0.84). Conclusions: The extent of bypassing the nearest childbirth facility in this rural Ugandan setting was associated primarily with the readiness of the nearest facility to provide care.