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

Abstract

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.