Bulletin of the World Health Organization

Bypassing primary care clinics for childbirth: a cross-sectional study in the Pwani region, United Republic of Tanzania

Margaret E Kruk, Sabrina Hermosilla, Elysia Larson & Godfrey M Mbaruku

Volume 92, Number 4, April 2014, 246-253

Table 3. Bivariate analysis comparing travel, payment, and quality of care among bypassers and non-bypassers, United Republic of Tanzania, 2012

Characteristica Bypassersb Non-bypassersc cOR (95% CI) P
Travel to facility            
Walked to facility 47 (5.9) 330 (30.1) 1.00  
Travelled by bicycle to facility 4 (0.5) 70 (6.4) 0.40 (0.14–1.15) 0.089
Travelled by motorcycle to facility 228 (28.8) 579 (52.7) 2.76 (1.96–3.89) < 0.001
Travelled by car or bus to facility 515 (64.9) 119 (10.8) 30.38 (21.10–43.77) < 0.001
Distance travelled (km), mean (SD) 36.8 (53.3) 10.6 (16.9) 1.04 (1.03–1.05) < 0.001
Payment for delivery            
Provider fees (US$), mean (SD) 2.2 (10.7) 2.4 (14.2) 1.00 (0.99–1.01) 0.731
Drugs, supplies, tests (US$), mean (SD) 5.0 (6.6) 3.6 (4.0) 1.06 (1.04–1.08) < 0.001
Transportation (US$), mean (SD) 6.0 (8.1) 2.0 (4.5) 1.20 (1.16–1.23) < 0.001
Total costs (US$), mean (SD)d 17.5 (28.4) 8.8 (15.9) 1.07 (1.00–1.08) < 0.001
Borrowed or sold asset to pay for health care 122 (15.5) 129 (11.9) 1.36 (1.04–1.78) 0.023
Services received during and after delivery            
Uterotonic 603 (76.1) 856 (78.3) 0.88 (0.71–1.10) 0.264
IV antibiotic or other drug 177 (22.3) 236 (21.6) 1.05 (0.84–1.30) 0.695
Blood transfusion 21 (2.7) 15 (1.4) 1.96 (1.00–3.82) 0.049
Baby examined before discharge 584 (74.8) 748 (60.0) 1.33 (1.08–1.64) 0.007
Mother examined before discharge 345 (43.5) 357 (32.7) 1.59 (1.31–1.92) < 0.001
Very good/excellent rating of elements of delivery care            
Respectful communication from health worker 381 (48.0) 443 (40.4) 1.36 (1.13–1.64) 0.001
Cleanliness of the delivery room 285 (36.0) 311 (28.5) 1.41 (1.16–1.72) 0.001
Privacy of the delivery room 317 (40.2) 426 (38.9) 1.05 (0.87–1.27) 0.577
Clarity of communication from health worker 310 (39.1) 370 (33.8) 1.26 (1.04–1.52) 0.017
Knowledge of the health worker 352 (44.6) 404 (36.9) 1.37 (1.14–1.65) 0.001
Availability of drugs and modern equipment 276 (35.3) 248 (22.9) 1.84 (1.50–2.25) < 0.001
Overall quality of care 468 (58.9) 511 (46.7) 1.64 (1.36–1.97) < 0.001
Very satisfied with the delivery experience 513 (64.6) 543 (49.5) 1.86 (1.54–2.24) < 0.001

CI, confidence interval; cOR, crude odds ratio; IV, intravenous; SD, standard deviation; US$, United States dollar.

a For all characteristics, data denote the ratio of the odds of the characteristic being reported by a bypasser (n = 794) to the odds of the characteristic being reported by a non-bypasser (n = 1104).

b Defined as women who delivered their youngest child at a health centre or hospital (secondary or tertiary level facility) and were not referred there by a health-care provider.

c Defined as women who delivered their most recent child at a primary care clinic.

d Includes costs of transportation, provider fees, drugs, supplies, tests and tips. For context, the Tanzanian per capita gross domestic product was US$ 474 in 2012.

Note: Data are for 1898 women. For some rows, denominators differ from 1898, owing to missing data.