Home Deliveries in Rwinkwavu District Hospital, Rwanda: Factor Associated with Recurrence of the Practice

Research Article

Home Deliveries in Rwinkwavu District Hospital, Rwanda: Factor Associated with Recurrence of the Practice

Muhire A1, Mukarwego B1, Muhimba I1,2, Bizimana GE1,3, Bagwaneza T4 and Rutayisire E1*

1Department of Public Health, Mount Kenya University, Rwanda

2Mugonero Hospital, Ministry of Health, Rwanda

3Jigsaw Consult/Refugee Education, UK

4Rwanda Biomedical Center, Rwanda

*Corresponding author: Erigene Rutayisire, Public Health Department, Mount Kenya University, Kigali, Rwanda

Received: June 09, 2021; Accepted: July 07, 2021; Published: July 14, 2021


Home delivery is persisting in developing countries. In Rwanda, 9% of mothers derived at home as reported in 2015 Demographic Health Survey. Delivering at home is associated with higher risk of maternal deaths. This study aims to investigate the rates of home delivery and associated factors. This study was a cross sectional study design with both qualitative and quantitative approaches. A convenience sampling was used to select 160 mothers for quantitative data. For qualitative data, 16 FGDs were conducted. Data were collected by using a structured questionnaire and interview guide. Quantitative data was analyzed using SPSS while qualitative data were thematically analyzed. A total of 160 mothers from 8 sectors of Kayonza district participated in the study. Of them 61.3% were aged less than 35 years, 70% were married, and 93.8% had attended primary education. The rate of delivering at home was 36.9% (deliver at home for two times or more). We found that mothers aged over 35 years were 3.5 times more likely to recurrently deliver at home than mothers aged between 15-35 years (OR=3.5; 95% CI: [1.80-6.96]; p<0.001). The odds of having a recurrence of home delivery was found to be 4 times higher among mothers with limited transport facilitation (OR=4.0; 95% CI: [1.01- 16.1]; p=0.047). Poverty, family conflicts, increase of teenage pregnancies, lack of health insurance, a lack of money to pay for a hospital services were mentioned as factors influencing recurrence of home delivery. There is a need to increase the support received by poor families in Rwanda.

Keywords: Home deliveries; Recurrence; Eastern province of Rwanda


Globally, about four million of newborns die within their first week of life, and approximately 529,000 mothers lose their lives to pregnancy related causes [1]. Many births in low and middleincome countries are still occurring at home with no assistance of skilled attendants [2]. This has led to great concerns because women who face life-threatening problems during their pregnancy and/or delivery need adequate and accessible care. It has been documented that around 20-30% of neonatal deaths could be prevented by implementing skilled birth care services [3].

It was revealed that if a mother gives birth at home at the first time they are more likely to give birth at home again [4]. Home delivery is one of the public health threats, as the mother and the newborn are at a relatively high risk for several complications during delivery, disabilities and even death due to their vulnerable health status. Home deliveries and pregnancy related complications are among the main causes of maternal mortality. In 2017, the annual global estimate of maternal deaths was 295,000, with 94% coming from less developed countries [5]. The majority of these deaths were preventable. In the same year, about two thirds of the estimated worldwide maternal deaths took place in Sub Saharan Africa [6]. A report from World Health Organization show that maternal mortality was 462 per 100000 in 2017 in low-income countries while SDGs target to reduce maternal mortality at or less than 70/100,000 live births by 2030 [5].

A qualitative study conducted in Burkina Faso confirmed that the two main barriers to facility-based delivery were geographical access in relation to conditions of roads and elevated transaction costs related to travel; and the sharing of fees that is still applied at the point of use [7]. A study conducted in Zambia revealed that home delivery is caused by sudden onset labor, transport difficulties to the closest health facility, poverty, as well as gender inequality, although it had a small percentage. Additionally, attitude is linked with home deliveries and staying at home alone when the labor starts [8]. In Ethiopia a study showed that among 67.2% of participants who gave birth at home, 89.6% were living in rural communities. The predictors of home deliveries included lack of education, older age, not watching TV, and poverty [9].

In Rwanda, the rates of delivery at health facilities have increased from 80% in 2010 to 90% in 2014-2015. As of 2018, 91% of deliveries were carried out at the health facilities by skilled health professionals [6]. Even though the percentages of mothers who deliver at health facilities have increased overtime, there are still a significant number of women who deliver at home, therefore exposed to a high risk of pregnancy related complications. These complications include hemorrhage, hygiene related infections and even death.

A study conducted in Rwanda demonstrated that predictors of home delivery were high parity, residential place for rural woman, low level of education, lower household income, none or one antenatal care visit and lack of antenatal counseling regarding pregnancy complications [10].

The Government of Rwanda has put in place various programs aiming to reduce maternal and child death such as the provision of health insurance to families that cannot afford to pay for their health insurances, decentralization of health facilities where each cell has a health post, strengthening community health workers service provision, etc.

Despite all these interventions that have been implemented to eliminate home deliveries, the number of home deliveries is still alarming. The prevalence of home deliveries in Rwanda was 9% and 11% in Eastern province was 11% in 2015. In 2019, a total 273 cases of home delivery were reported in Kanyonza District [11]. Therefore, it is of great importance to carry out this study in order to assess the reasons behind recurrence of home deliveries regardless all interventions that have been made available to strengthen birth assisted by healthcare professionals. The results from this study should help in establishing more realistic, effective and evidence based interventions needed to ensure that pregnant women deliver at health facilities.

Materials and Methods

Study design and target population

A cross sectional study design with both qualitative and quantitative approach was used to assess the factors associated with home deliveries and challenges faced by mothers after home delivery. Three groups of people, namely mothers who delivered at home, Community Health Workers (CHWs) who are responsible for those mothers as well as socio-economic and development officer at cell level were included in the study. For mothers, focus group discussions as well as in person interviews were conducted. This research was carried out in Kayonza district, specifically in Rwinkwavu District Hospital catchment area, and the study participants were selected among the mothers who delivered at home from August 2018 to July 2019. Kayonza District is located in Eastern province; and the district has 12 sectors.

Sample size and sampling procedure

The following formula was used to calculate the sample size n for mothers who delivered at home.

n= z2*N/z2+ (i2*(N-1))

Z = Standard normal distribution curve value for 95 % CI which is 1.96

N = Population size

I = Reduced margin of error


Therefore, a convenience sampling was used to select 20 up 30 mothers in each sector, to make a total of 160 mothers for quantitative data collection. For qualitative data, Focus Group Discussions (FGDs) with the mothers were carried out in all sectors prior to in person interviews. Two FGDs were conducted in each sector where one FGD was composed of the mothers while the other group will be of CHWs and SEDOs. For the latter, 8 members composed each FGD: 4 CHWs and 4 sector officers in charge of social affairs A total of 32 CHWs and 32 social affairs officers were selected for in person interviews and FGDs.

Data analysis and ethical consideration

Data were collected and cleaned to ensure its completeness and accuracy by using SPSS for quantitative data. A multivariate logistic regression model has been used to calculate odds ratio and the corresponding 95% confidence interval. A two tailed p-value of less than or equal to 0.05 has been used in order to state the statistical significance or not. Qualitative data was classified and coded into themes and concepts. Key information and quotations were synthetized and tabulated in order to know the information saturation.

The approval was obtained from Mount Kenya University Rwanda ethical review board. All data collected were treated anonymously. Neither the participants nor the health facilities’ names or address appeared on the questionnaire. The participants’ names and addresses were only used initially to identify their location, but the data collection was done anonymously. All confidential information was protected. There were no risks associated with the study. The participants benefited from the evidence based interventions that have been put in place upon this study’s recommendations.


Socio-demographic characteristics of women who delivered at home

The most respondents were aged between 15 and 35 years (61.3%), 70% were married, 93.8% had attended primary education, 87.5% were unemployed, 53.1% had monthly revenue under 30,000RWF, 35% had husbands aged between over 35 years, and 54.4% of respondents’ husbands had primary education level. More than a half of respondents (52.5%) revealed that the distance between the nearest health facility and the mother’s home lies between 2 and 5 kilometers. In average, each mother has given at least one birth (Mean = 1.43 and Std. Deviation = 0.56), 60.0% of the respondents have between 1 and 3 children, 93.1% said that they have delivered at the health facility while 90.6% of them have delivered at home between 0 and 3 children. Less than half of mothers surveyed were in the second and third social category respectively with 38.8% and 43.8%. Among them, 79.4% assumed they were enrolled in the family planning program. The majority (83.6%) have subscribed to the health insurance. Christians were representing 26.3% of the total respondents versus 66.3% without religion (Table 1).