|Year : 2019 | Volume
| Issue : 1 | Page : 12-17
Determinants of birth registration of children under 5 years in Uganda
Douglas Andabati Candia
Department of Planning and Applied Statistics, Makerere University, Kampala, Uganda
|Date of Submission||12-Sep-2018|
|Date of Acceptance||20-May-2019|
|Date of Web Publication||10-Jul-2019|
Mr. Douglas Andabati Candia
Department of Planning and Applied Statistics, Makerere University, P. O. Box: 7062, Kampala
Source of Support: None, Conflict of Interest: None
Background: In Uganda, only about one-third (32%) of children under age 5 have their births registered with the civil authority. There is limited information on factors linked to birth registration in Uganda. Therefore, the main objective of this study was to identify the factors associated with birth registration in Uganda. Methods: Data from the Uganda Demographic and Health Survey 2016 were analyzed. The study sample comprised only women from 16,206 households who had children years, selected using two-stage stratified sampling with probability proportional to size. A logistic regression model was used to study the determinants of birth registration. Results: The overall coverage of birth registration was 32.7%. Child's age, health-care provider, ownership of a radio or mobile phone, and region of residence were significantly associated with birth registration. On the contrary, relationship to the household head, age of the household head, television ownership, wealth index, and residence had no association with birth registration status. Conclusion: Birth registration is relatively still low in Uganda. The Government of Uganda should bring the birth registration services closer to health facilities, especially low-level health centers. The government should utilize mobile phone and radio technologies to promote and sensitize communities about birth registration due to their mass coverage and positive association with birth registration.
Keywords: Birth registration, mass media, Uganda
|How to cite this article:|
Candia DA. Determinants of birth registration of children under 5 years in Uganda. Int J Adv Med Health Res 2019;6:12-7
| Introduction|| |
Birth registration is “the continuous, permanent, and universal recording, within the civil registry, of the occurrence and characteristics of births in accordance with the legal requirements of a country.” Children have a right to be identified as nationals of a specific country or countries. However, worldwide, close to 230 million children under 5 years have never been registered resulting in their inability to obtain a birth certificate, denial of health care, education, formal employment, ownership of property, and right to vote among other amenities. The situation is not so much different in Uganda with only 32% of children under 5 years of age having their births registered with the civil authority.
Some of the barriers to birth registration include distance to registration center, lack of knowledge on child registration process, charging registration fees, traditional customs, and practices which discourage formal birth registration among others. The low coverage of birth registration in sub-Saharan African countries has been attributed to many factors. Maternal age and education, religion, household wealth, residence (rural or urban), place of delivery, occupation, sex, and age of the child are some of the factors that have been found to be associated with a child's registration status.,,,,
]Although exposure to mass media has been studied with regard to its impact on other public health issues such as family planning and health service utilization, it has received little attention with regard to its association with birth registration. This study, therefore, took into consideration the influence of mass media including mobile phones, television, and radio which have been found to influence behavioral changes in recipients of information through them., Given the limited empirical evidence on birth registration determinants, especially in Uganda, this study would contribute to addressing this gap by identifying factors associated with the birth registration status of a child. The study also explored the contribution of mass media to improve birth registration.
| Methods|| |
The data used in this study were from the 2016 Uganda Demographic and Health Survey (DHS). Authorization to download and use the data was sought from the DHS Program Office upon registration of this study. The sample was stratified and selected in two stages. First, 697 enumeration areas (EAs) were selected from the 2014 Uganda National Population and Housing Census comprising 162 EAs in urban areas and 535 in rural areas. The sample EAs were selected independently from each stratum using probability proportional to size. At the second stage of sampling, households were selected. A listing of households was compiled in each of the 696 accessible selected EAs. Every EA that was selected and had >300 households was segmented, and one segment was selected for the survey with probability proportional to segment size and within these segments household listing was conducted. In total, a representative sample of 20,880 households (30 per EA or EA segment) was randomly selected. This study specifically considered only households that had children aged years since only these were eligible to respond to the question concerning the registration status of children. Therefore, the final sample size considered for this study was of 16,206 households.
The data were analyzed using STATA Version 14.2 at three stages. First, a descriptive summary of all plausible independent variables and birth registration status of children was done using frequencies and percentages. Second, using the Pearson's Chi-square test, association between the birth registration status of a child and the plausible independent variables was tested. Independent variables that turned out significant (P ≤ 0.05) at this level were considered for further analysis. Finally, given that the dependent variable, birth registration was measured on a dichotomous scale, that is, either a child was registered or not, a logistic regression model was fitted to determine the independent determinants at 5% level of significance.
| Results|| |
[Table 1] presents a descriptive summary of the sociodemographic and socioeconomic characteristics of the study participants. Based on the study findings, majority of the children were unregistered (67.3%). Majority of the children were males (50.3%) compared to females (49.8%). The highest proportion of children was aged 48–59 months (21.4%) and 36–47 months (30%) with the least aged months (19.6%). Regarding relationship of the children to the heads of households they resided in, majority were either sons or daughters (75.2%), followed by grandchildren (18.4%) and the rest being other relatives (6.4%). Majority of the households interviewed were headed by males (74.1%). The highest proportion of household heads was aged 45 years and above (29.6%), followed by those aged 30–34 years (18.6%), and the least aged below 25 years (8.3%). Majority of the households had radio (55.5%), did not have a television (87.8%), and had at least one household member with a mobile phone (74.6%). Concerning where households go for health care, majority used government health centers (66.4%), followed by private hospitals or clinics (21.2%), government hospitals (10.2%), and the minority used other health-care providers (2.2%). As regards wealth status, the highest proportion of the households belonged to the poorest (26.2%) and poorer (22%) wealth index. The highest proportion of households resided in the eastern (29.5%) and western (25.8%) regions. Majority of the households resided in rural areas (82.5%).
[Table 2] provides a summary of the results of associations between registration status of children under 5 years and the plausible independent variables. Apart from a child's sex and sex of the household head, the rest of the plausible variables had a significant association with the registration status of a child. Concerning a child's age, children aged 36–47 months (36.4%) and 48–59 months (35%) had the highest proportion registered while those aged <12 months (26.1%) having the least. Children who were sons or daughters of household heads had the highest proportion registered (33.9%) compared to those who were either grandchildren (31.1%) or other relatives (23.6%). Children from households with heads aged 30–34 years (34.8%) had the highest proportion registered, followed by those aged 25–29 years (34.5%), and the least were among those aged below 25 years (30.7%). Children from households that had a radio (34.3%), a television (37.9%), and at least one member having a mobile phone (33.6%) had higher proportions registered compared to those that did not. Children from households that sought health care from government hospitals (38%), private hospitals or clinics (34.5%), and government health centers (31.7%) had higher registration proportions than those who sought health care from other sources (22.1%). Regarding wealth index, children from households in the richest (38.5%) and richer (32.4%) wealth index had the highest proportion registered. As for the region of residence, children who resided in the northern region (42.6%) had the highest number registered, followed by the western (35.8%) and central (32.3%) regions and finally the eastern region (22.2%).
|Table 2: Association between registration status and plausible independent variables|
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[Table 3] provides a summary of the results from the logistic regression model. Apart from age of the household head, ownership of a television, and residence, the rest of the plausible independent variables had a significant effect (P ≤ 0.05) on the registration status of a child. Children aged 12–23 months (adjusted odds ratio [aOR] = 1.32), 24–35 months (aOR = 1.48), 36–47 months (aOR = 1.65), and 48–59 months (1.56) were more likely to be registered compared to those aged months. Regarding relationship to the household head, children who were other relatives (aOR = 0.62) were less likely to be registered compared to sons or daughters of the household heads. Children from households with a radio (aOR = 1.14) were more likely to be registered than those without. Similarly, children from households where at least one member has a mobile phone (aOR = 1.16) were more likely to be registered compared to those from households without. Children from households that sought health care from government health centers (aOR = 0.80), private hospitals or clinics (aOR = 0.88), and other health providers (aOR = 0.58) were less likely to be registered compared to those who sought health care from government hospitals. Children from the richest wealth index (aOR = 1.39) were more likely to be registered compared to those from the poorest wealth index. Children who resided in the eastern region (aOR = 0.74) were less likely to be registered compared to those from the central region. On the contrary, children from the northern (aOR = 2.06) and western (aOR = 1.34) regions were more likely to be registered compared to those from the central region.
| Discussion|| |
This study sought to explore the factors that positively or negatively influenced birth registration of children under 5 years in Uganda. The significance of the child's age was consistent with findings from a study in Ghana that also reported an increased likelihood of being registered among older children. This could be attributed to the fact that older children are about to enroll in formal schooling, and a birth certificate is required before admission leaving parents with no option but to process one for their child. As for nonschool going children, parents may not see the need for processing a birth certificate since it is hardly required during the early years of a child apart from during school admission, hence reducing the likelihood of nonschool-going children being registered. The positive effect of radio and mobile phone ownership has been reported in other studies on the use of contraceptives and utilization of insecticide-treated nets, antenatal care services, and postnatal care services., The impact of radio and mobile phones can be attributed to the fact that most people in Uganda reside in rural areas which have limited coverage for other forms of mass media such as newspapers and television whereas radio and mobile phone coverage is relatively large across the country. Second, other mass media are relatively expensive to own for the predominantly poor rural households. Finally, Uganda has over 200 radio stations airing in different languages enabling effective communication to people from geographical, socioeconomic, education, ethnic, and tribal backgrounds. The significance of the health-care provider is consistent with findings from a study conducted in Lao PDR which reported an increased likelihood of birth registration for children born in government hospitals. This can be attributed to the fact that registration of births and issuance of short birth certificates is mandatory for all births in government hospitals with data being tracked regularly through the Mobile Vital Records System. Even though the system is meant to track births in the community outside health facilities as well, compliance by other places of delivery has not been good, especially with regard to deliveries by traditional birth attendants. Significant regional differences in birth registration were also evident. This can be attributed to regional differences in access to social services in Uganda such as health services with mothers having to travel long distances to receive maternal health-care services. Many are discouraged and opt to use traditional birth attendants who are within their communities and subsequently resulting in having unregistered births.
| Conclusion|| |
Based on the study findings, the likelihood of a child being registered increased with a child's age. Birth registration was highest in children, aged 36–47 months, delivered from government hospitals as well as those residing in households located in the northern and western regions. The likelihood also increased in households which owned at least a mobile phone or radio. Therefore, it is recommended that the government enforces the registration of new births and brings the services closer to the health facilities, especially lower level government health facilities as well as private hospitals and clinics, since births in such settings are least likely to be registered. The government should utilize mobile phone and radio technologies to promote and sensitize communities about birth registration due to their mass coverage and positive association with birth registration. These are highly accessible to people, especially in rural areas, who cannot afford televisions or newspapers. Furthermore, there is a need to extend birth registration services, especially to the eastern region through sensitization drives as well as equip personnel working in the region for instance on how to register births using mobile platforms.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]