{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T20:00:25Z","timestamp":1765742425780,"version":"3.41.0"},"reference-count":75,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2017,7,10]],"date-time":"2017-07-10T00:00:00Z","timestamp":1499644800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2017,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Skilled attendance at birth is key for the survival of pregnant women. This study investigates whether women at increased risk of maternal and newborn complications in four East African countries are more likely to deliver in a health facility than those at lower risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Demographic and Health Survey data for Kenya 2014, Rwanda 2014\u201315, Tanzania 2015\u201316 and Uganda 2011 were used to study women with a live birth in the three years preceding the survey. A three\u2010level obstetric risk index was created using known risk factors. Generalised linear Poisson regression was used to investigate the association between obstetric risk and facility delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We analysed data from 13\u00a0119 women across the four countries of whom 42\u201345% were considered at medium risk and 12\u201317% at high risk, and the remainder were at low risk. In Rwanda, 93% of all women delivered in facilities but this was lower (59\u201366%) in the other three countries. There was no association between a woman's obstetric risk level and her place of delivery in any country; greater wealth and more education were, however, independently strongly associated with facility delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In four East African countries, women at higher obstetric risk were not more likely to deliver in a facility than those with lower risk. This calls for a renewed focus on antenatal risk screening and improved communication on birth planning to ensure women with an increased chance of maternal and newborn complications are supported to deliver in facilities with skilled care.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.12910","type":"journal-article","created":{"date-parts":[[2017,6,19]],"date-time":"2017-06-19T05:23:23Z","timestamp":1497849803000},"page":"1081-1098","source":"Crossref","is-referenced-by-count":11,"title":["Who delivers where? The effect of obstetric risk on facility delivery in East Africa"],"prefix":"10.1111","volume":"22","author":[{"given":"Sandra","family":"Virgo","sequence":"first","affiliation":[{"name":"Faculty of Epidemiology and Population Health London School of Hygiene &amp; Tropical Medicine London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giorgia","family":"Gon","sequence":"additional","affiliation":[{"name":"Faculty of Epidemiology and Population Health London School of Hygiene &amp; Tropical Medicine London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca L.","family":"Cavallaro","sequence":"additional","affiliation":[{"name":"Faculty of Epidemiology and Population Health London School of Hygiene &amp; Tropical Medicine London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wendy","family":"Graham","sequence":"additional","affiliation":[{"name":"Faculty of Epidemiology and Population Health London School of Hygiene &amp; Tropical Medicine London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susannah","family":"Woodd","sequence":"additional","affiliation":[{"name":"Faculty of Epidemiology and Population Health London School of Hygiene &amp; Tropical Medicine London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,7,10]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Indicators I\u2010AaEGoM.The Millennium Development Goals Report 2015. United Nations 2015."},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69381-1"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.06.038588"},{"key":"e_1_2_8_5_1","doi-asserted-by":"crossref","DOI":"10.1596\/13652","volume-title":"Brazil: are Health and Nutrition Programs Reaching the Neediest?","author":"Barros AJ","year":"2005"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12634"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000206182.63788.80"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3016.1994.tb00490.x"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)14896-9"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/71.5.1280s"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0707943"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12647"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-7292(01)00407-6"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/15.8.1856"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1159\/000293273"},{"key":"e_1_2_8_16_1","unstructured":"PullumTW.An assessment of the quality of data on health and nutrition in the DHS Surveys 1993\u20102003 2008."},{"volume-title":"Uganda Clinical Guidelines","year":"2012","author":"Ministry of Health Republic of Uganda","key":"e_1_2_8_17_1"},{"volume-title":"National Guidelines for Quality Obstetrics and Perinatal Care","author":"Ministry of Public Health and Sanitation and Ministry of Medical Services Republic of Kenya","key":"e_1_2_8_18_1"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-3156.1996.d01-83.x"},{"volume-title":"Maternal Nutrition and Pregnancy Outcomes: Anthropometric Assessment","year":"1991","author":"Krasovec K","key":"e_1_2_8_20_1"},{"key":"e_1_2_8_21_1","unstructured":"MukuriaA AboulafiaC ThemmeA.The context of women's health: results from the Demographic and Health Surveys 1994\u20102001 2005."},{"key":"e_1_2_8_22_1","first-page":"465","article-title":"Vaginal birth after cesarean: a meta\u2010analysis of morbidity and mortality","volume":"77","author":"Rosen MG","year":"1991","journal-title":"Obstet Gynecol"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12807"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12443"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.4103\/0256-4947.67075"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyq195"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-7-168"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-789X.2008.00537.x"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2005.00437.x"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2007.03.027"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/640291"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2003.09.058"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc06-2559a"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-536x.2000.00033.x"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199902253400801"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(98)80010-0"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12891"},{"key":"e_1_2_8_38_1","first-page":"717","article-title":"Risk factors for early infant mortality in Sarlahi district, Nepal","volume":"81","author":"Katz J","year":"2003","journal-title":"Bulletin World Health Organization"},{"key":"e_1_2_8_39_1","unstructured":"WHO.Antenatal care and maternal health: how effective is it. A review of evidence 1992. Contract No.: 11."},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/ppe.12032"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-3016.1999.00160.x"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60792-3"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2015.04.024"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0114843"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1186\/1742-4755-12-S2-S8"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000158118.75532.51"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199510123331501"},{"key":"e_1_2_8_48_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/15.11.2433"},{"key":"e_1_2_8_49_1","doi-asserted-by":"publisher","DOI":"10.1186\/1742-4755-10-40"},{"volume-title":"The DHS Wealth Index: Approaches for Rural and Urban Areas","year":"2008","author":"Rutstein SO","key":"e_1_2_8_50_1"},{"key":"e_1_2_8_51_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwg074"},{"key":"e_1_2_8_52_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwh090"},{"key":"e_1_2_8_53_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-9-34"},{"key":"e_1_2_8_54_1","first-page":"438","article-title":"Overcoming access barriers for facility\u2010based delivery in low\u2010income settings: insights from Bangladesh and Uganda","volume":"24","author":"Parkhurst JO","year":"2006","journal-title":"J Health Popul Nutr"},{"key":"e_1_2_8_55_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-7-29"},{"key":"e_1_2_8_56_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-015-0695-9"},{"volume-title":"Kenya Demographic and Health Survey 2014","year":"2015","author":"Kenya National Bureau of Statistics (KNBS) and ICF International","key":"e_1_2_8_57_1"},{"volume-title":"Tanzania Demographic and Health Survey 2015\u201016","year":"2016","author":"Ministry of Health Community Development Gender Elderly and Children [Tanzania Mainland]; Ministry of Health [Zanzibar]; National Bureau of Statistics; Office of the Chief Government Statistician and ICF","key":"e_1_2_8_58_1"},{"volume-title":"Rwanda Demographic and Health Survey 2014\u201015","year":"2015","author":"National Institute of Statistics of Rwanda (NISR) [Rwanda]; Ministry of Health (MOH) [Rwanda]; and ICF International","key":"e_1_2_8_59_1"},{"volume-title":"Uganda Demographic and Health Survey 2011","year":"2012","author":"Uganda Bureau of Statistics (UBOS) and ICF International Inc","key":"e_1_2_8_60_1"},{"volume-title":"WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience","year":"2016","author":"World Health Organization","key":"e_1_2_8_61_1"},{"volume-title":"WHO Recommendations on Health Promotion Interventions for Maternal and Newborn Health","year":"2015","author":"World Health Organization","key":"e_1_2_8_62_1"},{"key":"e_1_2_8_63_1","doi-asserted-by":"crossref","DOI":"10.31899\/rh4.1177","volume-title":"Acceptability and Sustainability of the WHO Focused Antenatal Care Package in Kenya: Population Council","author":"Birungi H","year":"2006"},{"key":"e_1_2_8_64_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2011.02923.x"},{"key":"e_1_2_8_65_1","unstructured":"The Service Provision Assessment. (Available from:http:\/\/dhsprogram.com\/What-We-Do\/Survey-Types\/SPA.cfm.) [27 May 2017]"},{"key":"e_1_2_8_66_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czp013"},{"volume-title":"Maternal Health Review Uganda","year":"2003","author":"Ssengooba F","key":"e_1_2_8_67_1"},{"key":"e_1_2_8_68_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2008.02173.x"},{"key":"e_1_2_8_69_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60293-7"},{"volume-title":"National Community Health Strategic Plan July 2013\u2010June 2018","year":"2013","author":"Ministry of Health Rwanda","key":"e_1_2_8_70_1"},{"volume-title":"Delivering Maternal Health. Why is Rwanda doing better than Malawi, Niger and Uganda?","year":"2012","author":"Chambers V","key":"e_1_2_8_71_1"},{"key":"e_1_2_8_72_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31528-8"},{"key":"e_1_2_8_73_1","first-page":"13","article-title":"Every pregnancy faces risks","volume":"1","author":"Graham W","year":"1998","journal-title":"Planned Parenthood Challenges"},{"key":"e_1_2_8_74_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69381-1"},{"key":"e_1_2_8_75_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-3016.2001.0150s1001.x"},{"key":"e_1_2_8_76_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0060761"}],"container-title":["Tropical Medicine &amp; International Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Ftmi.12910","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tmi.12910","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T19:03:18Z","timestamp":1750359798000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/tmi.12910"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,7,10]]},"references-count":75,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2017,9]]}},"alternative-id":["10.1111\/tmi.12910"],"URL":"https:\/\/doi.org\/10.1111\/tmi.12910","archive":["Portico"],"relation":{},"ISSN":["1360-2276","1365-3156"],"issn-type":[{"type":"print","value":"1360-2276"},{"type":"electronic","value":"1365-3156"}],"subject":[],"published":{"date-parts":[[2017,7,10]]}}}