Training of Mothers for Attitude Change to Support Community Based Referrals for Maternal Outcome in East-Central Uganda

Abstract

In many developing countries, vehicle and motorcycle ambulances have been secured to transport mothers to health centres and the Village Health Teams (VHTs) have been involved in the community referral processes. However, the willingness of mothers to embrace the referral system is still a challenge. The consequences are dire with low health facility-based deliveries and escalating maternal mortality ratio (MMR) and infant mortality rates (IMR) in Uganda. The East-Central study investigated the attitude of mothers towards the use of local motorcycle (boda-boda) transport as a community-based referral means to health centres for a better maternal outcome (deliveries at health centres). A non randomized control trial study design of intervention was conducted in Iganga and Bugiri districts of East-Central Uganda. The study population consisted of 503 mothers (255 in the intervention arm and 248 in the control arm) randomly selected. Self-administered structured questionnaires, in-depth and key informant interviews and focus group discussions were used to collect both quantitative and qualitative data. Quantitative data were analyzed using STATA version 14. Thematic analysis was done using atlas Ti 7 software. Mothers with a positive attitude were 56.962 times more likely to deliver from health centres compared to those with negative attitude and was statistically significant (p=0.000). The average value to determine the change effect on using the difference-in-difference (DID) model was -0.654 and statistically significant (p=0.000). The positive attitude of mothers towards the comfort of boda-boda transport for mothers to health centres to deliver was statistically significant (p=0.011; OR=8.352; CI= 1.620 – 43.048). Massively, mothers are encouraged to contact boda-boda riders for transport services. The quality of boda-boda transport services should be good to enable mothers to change their mindset and positively embrace boda-boda transport for better maternal outcome.