Background
Methods
Setting
Sampling
Analysis
Results
Household survey: Facility type as a stronger predictor of early discharge than patient characteristics
Stayed < 24 hour n (row %) | Stayed ≥ 24 hours n (row %) | P value | ||
---|---|---|---|---|
Delivery Type | Normal vaginal delivery | 692 (62.7) | 413 (37.3) | <0.001 |
Cesarean section | 10 (10.5) | 85 (89.5) | ||
Assisted vaginal delivery | 2 (40.0) | 3 (60.0) | ||
Delivery Complicationsa | No | 620 (61.2) | 393 (38.8) | <0.001 |
Yes | 83 (44.1) | 105 (55.9) | ||
Birth Timing | Preterm birth | 9 (30.0) | 21 (70.0) | 0.001 |
Term | 700 (59.5) | 477 (40.5) |
Stayed < 24 hours Frequency (%) | Stayed ≥ 24 hours Frequency (%) | Crude Odds Ratiod (95 % CI), bivariate logistic regression | Adjusted Odds Ratio (95 % CI), final multiple logistic regression model | |
---|---|---|---|---|
596 (65.7) | 311 (34.3) | |||
Place of delivery | ||||
p < 0.001
|
p < 0.001
| |||
Hospital | 124 (53.9) | 106 (46.1) | 1 | 1 |
Health Center | 186 (63.7) | 106 (36.3) | 0.67 (0.42–1.05) | 0.70 (0.45–1.10) |
Dispensary | 286 (74.3) | 99 (25.7) | 0.40 (0.27–0.61) | 0.43 (0.29–0.65) |
Educatione | ||||
p = 0.013
|
p = 0.070
| |||
None | 153 (73.2) | 56 (26.8) | 1 | 1 |
Some Primary | 58 (63.7) | 33 (36.3) | 1.55 (0.95–2.55) | 1.40 (0.84–2.33) |
Primary Complete | 344 (63.1) | 201 (36.9) | 1.60 (1.21–2.11) | 1.47 (1.11–1.96) |
Secondary or Higher | 32 (65.3) | 17 (34.7) | 1.45 (0.84–2.51) | 1.26 (0.72–2.19) |
Age | ||||
p = 0.015
|
p = 0.140
| |||
≤19 | 74 (54.8) | 61 (45.2) | 1 | 1 |
20–33 | 414 (67.1) | 203 (32.9) | 0.59 (0.42–0.85) | 0.61 (0.38–0.99) |
34–49 | 107 (69.5) | 47 (30.5) | 0.53 (0.32–0.88) | 0.64 (0.33–1.23) |
Parity | ||||
p = 0.064
|
p = 0.154
| |||
1 | 123 (61.2) | 78 (38.8) | 1 | 1 |
2–3 | 236 (63.1) 2 | 138 (36.9) | 0.92 (0.66–1.29) | 1.37 (0.89–2.10) |
4+ | 36 (71.7) | 93 (28.3) | 0.62 (0.41–0.94) | 0.93 (0.52–1.65) |
Qualitative interviews: How a facility's structural limitations and routines compel an early departure
1. Facility based limitations and routines |
1) Pressure to discharge healthy mothers to accommodate others a) Limited supply of beds 2) Mass discharges regardless of delivery time a) “I left when the doctor was doing his rounds” 3) Discharges correspond with operating hours a) “I left when the dispensary was closing (for the day)” |
2. Facility factors’ effect on those who accompany women |
1) Facilities are uncomfortable for companions a) Facilities lack places to cook, sleep or do laundry i) Companions are left sleeping on floors, outside |
3. Facility factors’ effect on womena |
1) Physical Discomfort - “Hospitals are uncomfortable” a) Crowding and noise i) Lack of beds, women doubling up on beds ii) Constant noise from babies, fellow patients iii) No space b) Lack of cleanliness i) “There is dirtiness everywhere” ii) “The hospital’s mosquito nets stink” iii) “Hospitals are full of illness and disease” c) Wanting water or food i) No water, insufficient water, long queues to fetch water, no access to hot water (for a post-birth hot water massage) ii) No food nearby, food nearby is too costly, nowhere to prepare food, nobody to prepare food 2) Mental Discomfort- “I could not be at ease” a) Not enough attendants, adequate number of attendants but attendants are rude b) Women feel guilty “taking beds” from those “who really need it” c) Nearby patients are ill, unconscious or dying; their families are grieving |
Facility-based limitations and routines
“Many pregnant mothers are waiting. When you leave, another woman gets the bed. Our wards are few and we are many. Like if you were to continue staying you would bring trouble for others… and the nurses tell us, ‘Now the time has come. You should go so that others can come.’”- Woman in Ulanga District
“Look! The space is not enough. And others are still there so you have to sleep two in one bed. One mother with a big stomach on this side and you with your baby on that side. It’s better you just go home.”-Woman in Ulanga District
“Our hospital needs beds! Many people are just sleeping on the floors. Other people are sleeping two per bed. Some have had operations and others have delivered safely. Those with operations are given priority to lie in beds.”- Woman in Kilosa District
Facilities as a source of unease for women and companions
“You stay there and that baby is crying, this one is crying … you cannot sleep. … I said if I have problems I will just return (to the facility) …. My home is home.”– Woman in Kilosa
“I personally … just don’t like to be there. It makes me feel bad when I see a patient … unmoving or unconscious. To see people who are sick. It’s like that for me. If I’m safe, I go.”- Woman in Ulanga
Other factors that compel early departure
Suggestions for promoting longer stays
“Stay longer … if you have delivered safely you can’t stay. The only time they say you stay for 24 h is if you have problems. We know the rules.”- Woman in Ulanga
“…it is the doctor who has that decision…He is the one who says when she can go. I don’t have the decision to say, ‘Wait.’”- Husband in Morogoro Rural