A community survey on maternal and child health services utilization in rural Ethiopia

Health care seeking for maternal and newborn illnesses in low- and middle-income countries: a systematic review of observational and qualitative studies

Background: In low- and middle-income countries, a large number of maternal and newborn deaths occur due to delays in health care seeking. These delays occur at three levels i.e. delay in making decision to seek care, delay in access to care, and delay in receiving care. Factors that cause delays are therefore need to be understand to prevent and avoid these delays to improve health and survival of mothers and babies.   

Methods: A systematic review of observational and qualitative studies to identify factors and barriers associated with delays in health care seeking.

Results: A total of 159 observational and qualitative studies met the inclusion criteria. The review of observational and qualitative studies identified social, cultural and health services factors that contribute to delays in health care seeking, and influence decisions to seek care. Timely recognition of danger signs, availability of finances to arrange for transport and affordability of health care cost, and accessibility to a health facility were some of these factors.

Conclusions: Effective dealing of factors that contribute to delays in health care seeking would lead to significant improvements in mortality, morbidity and care seeking outcomes, particularly in countries that share a major brunt of maternal and newborn morbidity and mortality.

Registration: PROSPERO CRD42012003236.

Factors Affecting Access to Healthcare: An Observational Study of Children under 5 Years of Age Presenting to a Rural Gambian Primary Healthcare Centre

Main Objective

Prompt access to primary healthcare before onset of severe illness is vital to improve morbidity and mortality rates. The Gambia has high rates of child mortality and research is needed to investigate contributing factors further. This study aimed to identify factors affecting access to primary healthcare for children <5 years (y) in rural Gambia focusing on delayed presentation and severe illness at presentation as indicators in a setting where primary healthcare is delivered free of charge.

Methods

Data were extracted from an electronic medical records system at a rural primary healthcare clinic in The Gambia for children (0–5y) between 2009 and 2012. First clinic attendances with malaria, lower respiratory tract infections (LRTI) and diarrhoeal disease, the main contributors to mortality in this setting, were identified and categorized as delayed/non-delayed and severe/non-severe representing our two main outcome measures. Potential explanatory variables, identified through a comprehensive literature review were obtained from an ongoing demographic surveillance system for this population. Variables associated with either delayed/non-delayed and/or with severe/non-severe presentations identified by univariate analysis (p<0.1) were assessed in multivariate models using logistic regression (p<0.05).

Results

Out of 6554 clinic attendances, 571 relevant attendances were identified. Delayed presentation was common (45% of all presentations) and there was a significantly reduced risk associated with being from villages with free regular access to transport (OR 0.502, 95%CI[0.310, 0.814], p = 0.005). Children from villages with free regular transport were also less likely to present with severe illness (OR 0.557, 95%CI[0.325, 0.954], p = 0.033).

Conclusions

Transport availability rather than distance to health clinic is an important barrier to accessing healthcare for children in The Gambia, and public health interventions should aim to reduce this barrier.

A qualitative study of women's perspectives of antenatal care in a rural area of Zimbabwe

OBJECTIVE

To describe the perspectives and experiences of women in their use of antenatal care and in their reasoning on specific antenatal care routines.

DESIGN

Two qualitative methods including focus group discussions and individual interviews were combined.

SETTING

: a rural district in Zimbabwe where a randomised control trial had been undertaken to introduce a new antenatal care package.

PARTICIPANTS

Forty-four women and twenty-four men participated in the study.

FINDINGS

Women were observed to take actions contrary to those assumed professionally acceptable in antenatal care generally and in some specific changed routines. Visits were to be reduced and weighing was to be omitted, but women, especially younger women, said they preferred more than the stipulated five goal oriented visits. One reason for this was the importance of being assured that the fetus was growing well. They considered that visits spaced too widely would make it difficult for service providers to help, should complications develop. On the other hand, older women (above 35 years old), a group professionally considered to be at high risk, were not so concerned with the visits. All the women said they wanted to be weighed at all the visits. The antenatal care visits are simply known as 'going for scale'. The health care providers complied by weighing the women without recording. Cultural beliefs had great influence, especially on the time a pregnancy is acknowledged and reported. It is believed that pregnant women and the pregnancy are vulnerable to witchcraft during the early period of pregnancy.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

We concluded that, whether in its traditional or new form, antenatal care ignores the experiences and views of women and the way they make sense of pregnancy and the care of pregnancy. The importance of understanding the perspectives of different stakeholders as the key to effective change is underlined.