Length-of-stay after a health facility birth and associated factors: analysis of data from three Sub-Saharan African countries.

OBJECTIVES

We estimated the length-of-stay (LOS) in the health facility after childbirth and identified associated factors in three sub-Saharan African countries.

DESIGN

Secondary analysis using data from the most recent Multiple Indicator Cluster Surveys.

SETTING

Multiple Indicator Cluster Surveys from Ghana, Malawi and Eswatini were selected.

PARTICIPANTS

Women aged 15-49 years who had a facility delivery in the two years preceding the survey were included.

MAIN OUTCOME MEASURES

Length-of-stay recorded in days and weeks were converted to hours and analysed as a continuous variable.

RESULTS

Length-of-stay was estimated for 9147 women, wherein 6610 women (median LOS and IQR: 36 36,60 hours), 1698 women (median LOS and IQR 36 10,60 hours) and 839 women (median-length-stay 36 36,60 hours) were from Malawi, Ghana and Eswatini respectively. Being from Ghana [RC, -20.6 (95%CI:-25.2 - -16.0)] and then Eswatini [RC: -13.0 (95%CI: -19.9 - -9.8)] and delivery in a government hospital [RC: -4.9 (95%CI -9.9- -0.3)] were independently associated with having a shorter LOS. Having a caesarean section, assistance by Nurses/Midwives or Auxiliaries/CHOs, single birth, heavier birth weight, and death of newborn before discharge increased the duration of stay.

CONCLUSIONS

Necessitating and facility factors are important determinants of length of stay. Socio-demographic characteristics, however, have a restricted role in influencing the duration of postpartum stay in sub-Saharan Africa. Further prospective research is required to identify more determinants and provide evidence for policy formulation and clinical guidelines regarding the safest time for discharge after delivery.

FUNDING

None declared.