Understanding Factors Associated with Facility Birth in the El Trifinio Sur Oeste Region of Guatemala

Presenter: Courtney Vetter, University of Colorado Hospital Center for Global Health

Objective: To evaluate a two-phase, prospectively created, clinical quality improvement database in order to determine the rate of facility birth at delivery among participants and factors and outcomes associated with facility birth vs. home birth in the Trifinio cohort.

Methods: A secondary analysis was performed using data from a two-phase, prospectively created, clinical quality improvement Pregnancy/Neonatal database, including women who delivered between October 22, 2012 and February 13, 2015.  Primary analysis addressed the percentage and 95% confidence interval (CI) of facility birth, and secondary analysis evaluated health care access, maternal demographics, and maternal/neonatal outcomes associated with facility birth. Statistics used percentages for categorical variables and mean for continuous measures, with between group differences tested using chi-square or two-sample t-tests.

Results: The study included 292 women. The rate of facility birth in the cohort was 66%. The rate of Cesarean section in the cohort was 31%.  The maternal factors associated with facility birth were self or spouse employment at the local banana plantation (P<0.001) and planned facility delivery (P < 0.003).   Interestingly, distance from the hospital, maternal education, parity, and completion of four prenatal visits were not significantly associated with facility birth.  No maternal mortalities were recorded, but the rate of maternal complications was higher in the cohort delivered in a facility. There was no difference in the rate of neonatal death or subsequent neonatal referral whether delivery occurred in a facility or at home.

Conclusions: In contrast to the literature only employment and planned site of delivery predicted facility birth in our cohort. More women with maternal complications delivered in a facility as would be expected. Neonatal outcomes were not different whether the mother delivered at home or in a facility.