By Kibuka Grace
Maternal and neonatal mortality rates are still high in Uganda. Safe delivery can reverse this situation. World Health Organisation recommends continuous companionship support for augmenting labour and increasing quality of maternity care. There was however scanty data on use of continuous companionship in Uganda, Kamuli district inclusive.
The study aimed at assessing the level of utilisation of continuous companionship during labour as well as the associated individual, health systems’ and socio-cultural factors.
This study was a mixed methods cross-sectional study. Utilisation of continuous companionship during labour was categorised into: ‘continuous companionship support as compared with ‘Partial companionship support and ‘No companionship support’. Data were collected from 331 postpartum mothers who had delivered from Kamuli hospital and Namwendwa HC IV and from 14 KIIs in the respective facilities using a designed structured questionnaire, an interview guide and a checklist. Ethical issues were adhered to as approved by Higher Degrees, Research and Ethics Committee/HDREC of Makerere University School of Public Health. Quantitative data were entered using Epidata 3.1 and exported to STATA 13.0 for cleaning, transformations and analysis. Modified Poisson regression model and thematic deductive content analysis were adopted for analysis of quantitative data and qualitative data respectively.
About 3% of the postpartum mothers did not have companionship support at all times from time of admission to delivery time; whereas 49% had continuous companionship support and 48% had only partial companionship support. The majority of the birth companions (41.43%) were mothers to the postpartum mothers whereas others were spouses (18.07%), sisters (17.76%) and other community members (1.56%). Most of the respondents received at least one form of physical support, that is, 92.18%, 87.84% and 82.64% at first, second and third stage of labour respectively which varied in form according to the stage of labour. Spiritual support was least received support by the mothers. Multivariate analysis indicated that only mother’s: education level (PR=1.14, p-value <0.01); income (PR= 0.91, p-value <0.01); area of residence (PR=0.91, p-value <0.01); birth preparedness (PR=0.89, p-value <0.01); mother’s knowledge on benefits of continuous companionship support (PR=0.74, p-value <0.001); and mother’s fears of being bewitched by the birth companions (PR=0.91, p-value=0.03) were significantly associated with continuous companionship support during labour.
Continuous companionship was common among birthing mothers in Kamuli district. Most of the companionship support was physical and emotional in nature. Attaining education below tertiary level was a facilitating factor to having continuous companionship support. On the contrary, irregular income, living in an urban area, inadequate birth preparedness, lack of knowledge on continuous companionship, fear of being bewitched, small labour rooms that do not guarantee privacy and restrictive health providers were deterrent to the use of continuous companionship. Educating communities and health workers on continuous companionship and improving quality of labour rooms might improve on the use of continuous companionship in Kamuli district.
Kibuka Grace is a psychologist, public health specialist, and research associate at IMI.