An analysis by structural equation modeling of contextual determinants of the use of maternal health services in Africa

Vissého D. Adjiwanou, Université de Montréal

Contextual factors play an important role in explaining the determinants of the use of health services in Africa. Unfortunately, the complex relationship between contextual factors and individual level characteristics is not accurately portrayed by conventional regression models. The objective of this study was to use structural equation modeling to show the influence of contextual variables on the presence of skilled attendance at birth in rural Africa. Analyses were performed using the software Mplus 6,11 (Muthén, 1998-2010) with the MLR (maximum likelihood parameter estimates that are robust to non-normality and non-independence of observations) estimator and the Monte Carlo numerical integration. Our results show that the community education level positively influences the likelihood of skilled birth attendance. However, the neighborhood woman autonomy or empowerment has no direct effect on the use of skilled birth attendance, nor indirectly through the woman’s autonomy.