Introduction
Methods
Data source: households living below poverty line in rural Upper Egypt
Ethical approval
Exposure: measures of socio-economic position
Outcome: maternal health-seeking behaviours
Confounders
Statistical analysis
Results
Levels of maternal health-seeking behaviour
Characteristic | Sample of women | Women with live birth | ANC users | Facility delivery users |
---|---|---|---|---|
Weighted sample size
|
2,242
|
1,266
|
1,143
| |
Woman age group | 18-24 (column %) | 7.0 | 8.6 | 8.3 |
25-29 | 24.3 | 24.1 | 26.8 | |
30-34 | 26.5 | 27.9 | 24.9 | |
35-39 | 26.0 | 26.0 | 23.4 | |
40 and above | 16.2 | 13.4 | 16.6 | |
Number of children | 1-2 (column %) | 10.5 | 12.8 | 13.7 |
in household | 3-4 | 39.5 | 38.6 | 41.9 |
5-6 | 39.5 | 39.4 | 35.1 | |
7 or more | 10.5 | 9.2 | 9.3 | |
Village size | Small (<6,500) (column %) | 18.4 | 20.3 | 20.4 |
Medium (6,500-14,499) | 31.3 | 29.5 | 27.8 | |
Large (>14,500) | 50.3 | 50.2 | 51.8 | |
District size | Small (<249K) (column %) | 37.2 | 35.8 | 32.2 |
Medium (250K-349K) | 26.8 | 26.1 | 25.2 | |
Large (>350K) | 36.0 | 38.1 | 42.6 | |
Governorate | Assiut (column %) | 60.9 | 63.3 | 64.6 |
Sohag | 39.1 | 36.7 | 35.4 | |
Socio-cultural resourcefulness | Mean | -0.002 | 0.075 | 0.076 |
SE | 0.042 | 0.052 | 0.052 | |
Economic resourcefulness | Mean | 0.057 | 0.082 | -0.012 |
SE | 0.032 | 0.036 | 0.034 | |
Dwelling quality | Mean | -0.020 | 0.007 | 0.012 |
SE | 0.034 | 0.035 | 0.037 | |
Woman´s status | Mean | 0.015 | -0.018 | 0.031 |
SE | 0.032 | 0.035 | 0.038 |
Health-seeking behaviour outcomeAnte-natal care (ANC) | Variable type | Samples and missing data | Distribution of outcome in analysed sample and 95% CI | ||||
---|---|---|---|---|---|---|---|
Eligible sample and recall period | Eligible sample (size) | Missing data (%) | Analysed sample (size) | ||||
1.
|
Used ANC
| Binary | All women with birth 5years prior to survey | 2,242 | - | 2,242 | 58.5% (55.6 - 61.4) |
2.
|
Regular use of ANC (4+ visits)
| Binary | All women with birth 5years prior to survey who used any ANC | 1,312 | 3.5 | 1,266 | 66.9% (63.6 - 70.1) |
Delivery care
| |||||||
3.
|
Delivered in a health facility
| Binary | All women with birth 5years prior to survey | 2,242 | <0.01 | 2,240 | 51.1% (46.1 - 56.0) |
4.
|
Used private delivery facility
| Binary | All women with birth 5years prior to survey who delivered in a health facility | 1,143 | - | 1,143 | 17.7% (13.1 - 23.6) |
Construction of latent variables capturing socio-economic position
Latent variable | CFI | TLI | RMSEA |
---|---|---|---|
Socio-cultural resourcefulness | 0.986 | 0.971 | 0.024 |
Economic resourcefulness | 0.974 | 0.963 | 0.020 |
Dwelling quality | 0.990 | 0.970 | 0.023 |
Woman´s status | 0.995 | 0.992 | 0.032 |
Component variables | Distribution | Standardised factor loading (SE) |
---|---|---|
A. Socio-cultural resourcefulness
| ||
Woman: years of education
| ||
Mean (95% CI) | 2.50 (2.15-2.84) | 0.706 (0.035) |
Woman: literacy
| ||
Illiterate (column %) | 70.7 | 0.745 (0.034) |
Reads/writes with difficulty | 8.1 | |
Reads/writes easily | 20.9 | |
Missing | 0.3 | |
Male head of household: years of education*
| ||
Mean (95% CI) | 4.92 (4.55-5.29) | 0.670 (0.043) |
Male head of household: occupational category*
| ||
Not in employment/no male head of household (column %) | 10.9 | 0.253 (0.032) |
Manual or Agricultural worker | 73.5 | |
Higher (Sales, Clerical, Professional) | 15.6 | |
School enrolment of children 7-18 years old (binary)
| ||
All children enrolled/No children 7-18 (%) | 89.5 | 0.459 (0.054) |
Identity documents among members of household (binary)
| ||
All members have identity documents (%) | 68.8 | 0.208 (0.043) |
Percentage of adult household members (18years+) that ever attended education
| ||
Mean (95% CI) | 49.8 (46.8-52.8) | 0.902 (0.037) |
B. Economic resourcefulness (rural)
| ||
Household asset ownership (binary)
| ||
Refrigerator (%) | 40.2 | 0.368 (0.046) |
Dwelling is a house or apartment (%) | 54.6 | 0.402 (0.036) |
Colour TV (%) | 42.7 | 0.223 (0.034) |
Washing machine (%) | 67.2 | 0.238 (0.063) |
Access to means of agricultural production (binary)
| ||
Own, co-own or rent land (%) | 13.1 | 0.780 (0.036) |
Own buffalo (%) | 10.2 | 0.670 (0.046) |
Own cows (%) | 3.8 | 0.650 (0.060) |
Own horse (%) | 13.7 | 0.735 (0.040) |
Own goat or sheep (%) | 12.3 | 0.641 (0.044) |
Own poultry (%) | 50.2 | 0.521 (0.030) |
Household consumption (binary)
| ||
Have access to ration card (%) | 56.5 | 0.405 (0.049) |
Youngest child of school age consumed fruit in last 24hours (%) | 15.3 | 0.236 (0.049) |
C. Dwelling quality
| ||
Dwelling utilities (binary)
| ||
Piped water connection (%) | 74.9 | 0.422 (0.066) |
Landline phone (%) | 5.9 | 0.197 (0.063) |
Electricity from public network (%) | 89.5 | 0.690 (0.096) |
Construction materials (binary)
| ||
Floor from cement, tile or plastic (%) | 36.8 | 0.651 (0.063) |
Ceiling from concrete or tile (%) | 41.6 | 0.711 (0.073) |
Walls from red brick (%) | 74.3 | 0.716 (0.084) |
D. Mobility and decision-making of female head of household
| ||
Mobility: leave the house
| ||
Not allowed (column %) | 2.3 | 0.874 (0.009) |
Allowed with permission | 70.2 | |
Allowed with notice/without permission | 27.5 | |
Missing | - | |
Mobility: go to the market
| ||
Not allowed (column %) | 28.6 | 0.697 (0.021) |
Allowed with permission | 44.3 | |
Allowed with notice/without permission | 27.1 | |
Missing | - | |
Mobility: go to hospital
| ||
Not allowed (column %) | 1.4 | 0.865 (0.011) |
Allowed with permission | 69.2 | |
Allowed with notice/without permission | 29.4 | |
Missing | - | |
Mobility: visit relatives
| ||
Not allowed (column %) | 3.5 | 0.814 (0.013) |
Allowed with permission | 67.0 | |
Allowed with notice/without permission | 29.5 | |
Missing | - | |
Mobility: visit neighbours
| ||
Not allowed (column %) | 10.8 | 0.732 (0.018) |
Allowed with permission | 46.4 | |
Allowed with notice/without permission | 42.8 | |
Missing | - | |
Mobility: run an errand
| ||
Not allowed (column %) | 19.6 | 0.538 (0.028) |
Allowed with permission | 51.7 | |
Allowed with notice/without permission | 28.7 | |
Missing | - | |
Decision-making about household budget
| ||
Someone else (column %) | 1.6 | 0.429 (0.029) |
Male head of household solely | 51.9 | |
Female head of household or jointly | 46.3 | |
Missing | 0.2 | |
Decision-making about visiting friends or family
| ||
Someone else (column %) | 0.6 | 0.457 (0.038) |
Male head of household solely | 61.3 | |
Female head of household or jointly | 37.8 | |
Missing | 0.3 |
Socio-cultural resourcefulness | Economic resourcefulness | Dwelling quality | Woman´s status | ||
---|---|---|---|---|---|
A. Correlation coefficients between socio-economic position variables and p-values
| |||||
Socio-cultural resourcefulness
| 1.0000 | ||||
Economic resourcefulness
| -0.0068 (0.749) | 1.0000 | |||
Dwelling quality
| 0.1687 (<0.001) | 0.0084 (0.691) | 1.0000 | ||
Woman´s status
| -0.0299 (0.157) | 0.0411 (0.052) | 0.0028 (0.896) | 1.0000 | |
B. Crude associations between area-level and socio-economic position variables
| |||||
Mean (SE) | Mean (SE) | Mean (SE) | Mean (SE) | ||
Village size
| Small (<6,500) | -0.016 (0.082) | -0.058 (0.078) | -0.105 (0.062) | 0.085 (0.096) |
Medium (6,500-14,499) | -0.048 (0.078) | 0.165 (0.047) | -0.070 (0.087) | -0.063 (0.075) | |
Large (>14,500) | 0.033 (0.084) | 0.032 (0.062) | 0.041 (0.054) | 0.037 (0.048) | |
p-value
|
0.200
|
<0.001
|
<0.001
|
0.017
| |
District size
| Small (<249K) | -0.085 (0.065) | 0.130 (0.042) | -0.080 (0.078) | -0.031 (0.046) |
Medium (250K-349K) | -0.028 (0.093) | 0.122 (0.061) | 0.031 (0.048) | 0.009 (0.102) | |
Large (>350K) | 0.105 (0.095) | -0.067 (0.070) | 0.003 (0.077) | 0.066 (0.056) | |
p-value
|
<0.001
|
<0.001
|
0.009
|
0.096
| |
Governorate
| Assiut | 0.018 (0.075) | -0.024 (0.050) | -0.012 (0.060) | 0.019 (0.046) |
Sohag | -0.033 (0.063) | 0.185 (0.045) | -0.032 (0.054) | 0.008 (0.066) | |
p-value
|
0.216
|
<0.001
|
0.564
|
0.791
|
Determinants of maternal health-seeking behaviour in Upper Egypt poor
Any ANC use
Variable | Any ANC | Regular ANC | Facility delivery | Private delivery care | ||||
---|---|---|---|---|---|---|---|---|
Sample size | 2,242 | 1,266 | 2,240 | 1,143 | ||||
OR (95% CI)
|
p-value
|
OR (95% CI)
|
p-value
|
OR (95% CI)
|
p-value
|
OR (95% CI)
|
p-value
| |
Socio-cultural resourcefulness*
| 1.16 (1.02-1.32) | 0.022 | 1.17 (1.01-1.36) | 0.038 | 1.14 (1.02-1.28) | 0.028 | 1.04 (0.85-1.27) | 0.705 |
Economic resourcefulness*
| 1.27 (1.08-1.49) | 0.004 | 0.97 (0.78-1.19) | 0.747 | 0.81 (0.69-0.95) | 0.009 | 0.91 (0.66-1.25) | 0.538 |
Dwelling quality*
| 1.10 (0.96-1.26) | 0.159 | 0.95 (0.80-1.12) | 0.512 | 1.08 (0.93-1.26) | 0.291 | 1.48 (1.07-2.04) | 0.019 |
Woman´s status*
| 0.92 (0.80-1.06) | 0.228 | 0.97 (0.80-1.16) | 0.707 | 1.07 (0.93-1.23) | 0.314 | 0.98 (0.76-1.26) | 0.852 |
Woman´s age group
| ||||||||
18-24 | 1.48 (0.87-2.40) | 0.147 | 0.70 (0.31-1.59) | 0.387 | 0.87 (0.46-1.62) | 0.649 | 1.39 (0.49-3.95) | 0.526 |
25-29 | 0.91 (0.69-1.20) | 0.500 | 0.83 (0.49-1.43) | 0.507 | 1.05 (0.82-1.36) | 0.676 | 0.52 (0.25-1.09) | 0.081 |
30-34 | 1.10 (0.82-1.48) | 0.503 | 0.90 (0.59-1.37) | 0.619 | 0.90 (0.67-1.22) | 0.516 | 1.23 (0.77-1.94) | 0.380 |
35-39 | 1 (ref) | 1 (ref) | 1 (ref) | 1 (ref) | ||||
40 and above | 0.64 (0.49-0.85) | 0.002 | 0.89 (0.55-1.44) | 0.639 | 1.45 (1.10-1.91) | 0.009 | 0.76 (0.44-1.29) | 0.300 |
Number of children
| ||||||||
1-2 | 1.62 (0.93-2.84) | 0.089 | 1.10 (0.55-2.22) | 0.784 | 2.07 (1.36-3.14) | 0.001 | 0.80 (0.32-2.02) | 0.628 |
3-4 | 0.99 (0.79-1.26) | 0.953 | 0.79 (0.57-1.10) | 0.156 | 1.40 (1.12-1.74) | 0.003 | 1.20 (0.73-1.97) | 0.456 |
5-6 | 1 (ref) | 1 (ref) | 1 (ref) | 1 (ref) | ||||
7 or more | 0.79 (0.56-1.11) | 0.167 | 0.87 (0.54-1.40) | 0.553 | 1.06 (0.74-1.51) | 0.751 | 1.06 (0.63-1.78) | 0.836 |
Governorate
| ||||||||
Assiut | 1 (ref) | 1 (ref) | 1 (ref) | 1 (ref) | ||||
Sohag | 0.78 (0.60-1.01) | 0.059 | 1.08 (0.80-1.46) | 0.589 | 0.78 (0.53-1.15) | 0.206 | 1.91 (0.97-3.74) | 0.060 |
Received any ANC
| ||||||||
No | 1 (ref) | 1 (ref) | ||||||
Yes | 1.96 (1.57-2.45) | <0.001 | 1.87 (1.16-3.01) | 0.011 |