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Fagbamigbe AF, Bello S, Salawu MM, Afolabi RF, Gbadebo BM, Adebowale AS. Trend and decomposition analysis of risk factors of childbirths with no one present in Nigeria, 1990-2018. BMJ Open 2021; 11:e054328. [PMID: 34887282 PMCID: PMC8663083 DOI: 10.1136/bmjopen-2021-054328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To assess the trend and decompose the determinants of delivery with no one present (NOP) at birth with an in-depth subnational analysis in Nigeria. DESIGN Cross-sectional. SETTING Nigeria, with five waves of nationally representative data in 1990, 2003, 2008, 2013 and 2018. PARTICIPANTS Women with at least one childbirth within 5 years preceding each wave of data collection. PRIMARY AND SECONDARY OUTCOME MEASURES The outcome of interest is giving birth with NOP at delivery defined as childbirth assisted by no one. Data were analysed using Χ2 and multivariate decomposition analyses at a 5% significance level. RESULTS The prevalence of having NOP at delivery was 15% over the studied period, ranges from 27% in 1990 to 11% in 2018. Overall, the prevalence of having NOP at delivery reduced significantly by 35% and 61% within 2003-2018 and 1990-2018, respectively (p<0.001). We found wide variations in NOP across the states in Nigeria. The highest NOP practice was in Zamfara (44%), Kano (40%) and Katsina (35%); while the practice was 0.1% in Bayelsa, 0.8% in Enugu, 0.9% in Osun and 1.1% in Imo state. The decomposition analysis of the changes in having NOP at delivery showed that 85.4% and 14.6% were due to differences in women's characteristics (endowment) and effects (coefficient), respectively. The most significant contributions to the changes were the decision-maker of healthcare utilisation (49%) and women educational status (24%). Only Gombe experienced a significant increase (p<0.05) in the level of having NOP between 2003 and 2018. CONCLUSION A long-term decreasing secular trend of NOP at delivery was found in Nigeria. NOP is more prevalent in the northern states than in the south. Achieving zero prevalence of NOP at delivery in Nigeria would require a special focus on healthcare utilisation, enhancing maternal education and healthcare utilisation decision-making power.
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Affiliation(s)
| | - Segun Bello
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Mobolaji M Salawu
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Rotimi F Afolabi
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
- Population and Health Research Entity, North-West University, Mmabatho, South Africa
| | - Babatunde M Gbadebo
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Ayo S Adebowale
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
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Spatial distribution and determinants of abortion among reproductive age women in Ethiopia, evidence from Ethiopian Demographic and Health Survey 2016 data: Spatial and mixed-effect analysis. PLoS One 2020; 15:e0235382. [PMID: 32598398 PMCID: PMC7323954 DOI: 10.1371/journal.pone.0235382] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 06/11/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Unsafe abortion remains a global public health concern and it is the leading cause of maternal mortality and morbidity. Despite the efforts made to improve maternal health care service utilization, unsafe abortion yet constitutes the highest maternal mortality in Sub-Saharan Africa (SSA) including Ethiopia. Although abortion among reproductive-age women is a common problem in Ethiopia, there is limited evidence about the spatial distribution and determinants of abortion. Therefore, this study aimed to investigate the spatial distribution and determinants of abortion among reproductive-age women in Ethiopia. METHODS A secondary data analysis was conducted using the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total of 12378 reproductive-age women were included in this study. The Bernoulli model was fitted using SaTScan version 9.6 statistical software to identify significant hotspot areas of abortion and ArcGIS version 10.6 statistical software was used to explore the spatial distributions of abortion. For the determinant factors, a mixed effect logistic regression model was fitted to take into account the hierarchical nature of the EDHS data. Deviance (-2LL), AIC, BIC, and ICC were used for model comparison. The AOR with a 95% CI was estimated for the potential determinants of abortion. RESULTS The overall prevalence of abortion in Ethiopia was 8.9% ranging from 4.5% in Benishangul to 11.3% in Tigray regions. The spatial analysis revealed that abortion was significantly varied across the country. The SaTScan analysis identified a total of 60 significant clusters, of these 19 clusters were primary clusters. The primary clusters were located in the northern part of the Tigray region (LLR = 26.6, p<0.01; RR = 2.63). In the multivariable mixed-effect logistic regression analysis; primary education [AOR = 1.36; 95% CI: 1.13, 1.64], rural residence [AOR = 4.96; 95% CI: 3.42, 7.18], protestant religion follower [AOR = 0.56; 95% CI: 0.42, 0.75], richest wealth status [AOR = 1.72; 95% CI: 1.24, 2.40], maternal age 45-49 years [AOR = 3.12; 95% CI: 1.52, 6.44], listening radio [AOR = 1.27; 1.01, 1.60], and watching television [AOR = 1.45; 1.04, 2.01] were significant determinants of abortion. CONCLUSIONS The prevalence of abortion remains unacceptably high in Ethiopia. The spatial distribution of abortion has been significantly varied across regions in Ethiopia. Having primary education, being rural, having media exposure, and being from the richest household were significantly associated with higher odds of abortion whereas being protestant religious followers were associated with lower odds of abortion. Therefore, the government should design public health programs targeting the identified hotspot areas of abortion and should scale up maternal health programs in rural areas, to reduce maternal morbidity and mortality.
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Hong SA, Winichagoon P, Khang YH. Rural–urban differences in socioeconomic inequality trends for double burden of malnutrition in Thailand 2005–2016. Eur J Clin Nutr 2019; 74:500-508. [DOI: 10.1038/s41430-019-0510-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 09/17/2019] [Accepted: 09/25/2019] [Indexed: 01/21/2023]
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Liabsuetrakul T, Sukmanee J, Thungthong J, Lumbiganon P. Trend of Cesarean Section Rates and Correlations with Adverse Maternal and Neonatal Outcomes: A Secondary Analysis of Thai Universal Coverage Scheme Data. AJP Rep 2019; 9:e328-e336. [PMID: 31673478 PMCID: PMC6821536 DOI: 10.1055/s-0039-1697656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 07/16/2019] [Indexed: 10/30/2022] Open
Abstract
Objectives The main purpose of this article is to estimate the trend and projection of cesarean section rates (CSRs) and explore correlations between CSRs with adverse maternal and perinatal outcomes, namely maternal mortality ratios (MMRs), rates of postpartum hemorrhage (PPH), neonatal mortality rates (NMRs), and birth asphyxia per 1,000 live births across all regions of Thailand. Study design A secondary analysis of the hospital-based database of pregnant women and newborns under the Thai Universal Coverage Scheme between January 2009 and December 2017 was conducted. Results Overall annual CSR significantly increased from 23.2% in 2009 to 32.5% in 2017. With the same rate of increase, the CSR of 59.1% was projected by the year 2030 that could be reduced to 30.0% if an annual rate of CS reduction of 1% was assumed using Joinpoint regression. The increasing CSRs were significantly correlated with higher MMRs ( r = 0.20, p = 0.03) and birth asphyxia ( r = 0.39, p < 0.001). The correlation trends were similar when the analyses were stratified by year in the majority of years. Overall correlations between CSRs and rates of PPH or NMRs were not statistically significant. Conclusion CSRs in Thailand continuously increased and were correlated with adverse maternal and perinatal outcomes. More effort at the national level to reduce unnecessary CS is urgently required.
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Affiliation(s)
- Tippawan Liabsuetrakul
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Jarawee Sukmanee
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Jutatip Thungthong
- National Health Security Office (NHSO) Thailand, Chaengwattana Road, Lak Si, Bangkok, Thailand
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Wong J, Macikunas A, Manduric A, Dawkins J, Dhunna S. Reaching the Hard to Reach in Thailand: Eliminating Mother-To-Child HIV Transmission. Health Syst Reform 2019; 6:1-7. [PMID: 31567056 DOI: 10.1080/23288604.2019.1625498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Thailand is the first country in the Asia-Pacific region to be validated by the World Health Organization as having eliminated mother-to-child transmission (MTCT) of HIV. The Thai government made health-and specifically addressing the HIV/AIDS crisis-a political priority. The Thailand experience, from the emergence of the HIV/AIDS epidemic in the 1980s through the present, provides an important case study of successful MTCT elimination. To eliminate MTCT requires that health interventions reach those who are hardest to reach: the poorest of the poor, geographically distant and rural, and marginalized. This policy report highlights key factors for successfully reaching the hard to reach in Thailand, including the importance of national public policy as well as investments in health care infrastructure, such as access to antenatal care, the creation of effective monitoring and surveillance systems, and strengthening local health capacity. Increased availability and affordability of antiretroviral therapies was also critical to Thailand's success in addressing MTCT. The Thailand case offers important policy lessons for achieving universal health. This policy report draws on secondary research and key informant interviews in Thailand to highlight factors for success in eliminating MTCT of HIV.
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Affiliation(s)
- Joseph Wong
- Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Canada
| | - Andrea Macikunas
- Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Canada
| | - Aylin Manduric
- Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Canada
| | - Joy Dawkins
- Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Canada
| | - Simran Dhunna
- Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Canada
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The experiences of Burmese healthcare interpreters ( Iam ) in maternity services in Thailand. Women Birth 2018; 31:e152-e161. [DOI: 10.1016/j.wombi.2017.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 05/24/2017] [Accepted: 09/12/2017] [Indexed: 02/03/2023]
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Srithanaviboonchai K, Srirak N, Pruenglampoo B, Thaikla K, Suwanteerangkul J, Khorana J, Danthamrongkul V, Paileeklee S, Pattanasattayavong U, Grimes DE, Grimes RM. Physicians' and nurses' thoughts and concerns about introducing neonatal male circumcision in Thailand: a qualitative study. BMC Health Serv Res 2018; 18:275. [PMID: 29642890 PMCID: PMC5896126 DOI: 10.1186/s12913-018-3093-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 04/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neonatal male circumcision (NMC) is an alternative approach to adult male circumcision for HIV prevention. Recent studies found that NMC was rarely performed in Thailand and that most Thai health professionals did not recognize that NMC could reduce the risk of HIV infection and would not want NMC services in their hospitals. This study explored the thoughts and concerns of Thai government health staff regarding the introduction of NMC in government health facilities as a public health measure. METHODS In-depth interviews with physicians, nurses and physician administrators from four different levels of government hospitals in four provinces representing 4 regions of Thailand were conducted after provision of education regarding the benefits and risks of NMC. Interviews were audio recorded and analyzed using Atlas.ti software to develop themes. RESULTS Six themes emerged from the data of 42 respondents: understanding of the benefits of NMC; risks of NMC; need for a pilot project; need for staff training and hospital readiness; need for parental/family education; and need for public awareness educational campaign. Major concerns included possible medical complications of NMC, infringement of child rights, and lack of understanding from staff and parents. The respondents emphasized the need for a clear policy, proper training of staff, financial and equipment support, and piloting NMC rollout before this measure could be fully implemented. CONCLUSIONS Thai health professionals who took part in this study expressed several concerns if NMC had to be performed in their health care facilities. There is significant preparation that needs to be done before NMC can be introduced in the country.
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Affiliation(s)
- Kriengkrai Srithanaviboonchai
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Namtip Srirak
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | - Kanittha Thaikla
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | - Jiraporn Khorana
- Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Vipa Danthamrongkul
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | | | | | - Deanna E. Grimes
- School of Nursing, University of Texas Health Science Center, Houston, Texas USA
- Baylor-UT Houston Center for AIDS Research, Houston, Texas USA
| | - Richard M. Grimes
- Baylor-UT Houston Center for AIDS Research, Houston, Texas USA
- Division of General Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas USA
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Abstract
In 1988, the generalised HIV/AIDS epidemic in Thailand began and in the same year the first HIV-exposed infant in Thailand was born at King Chulalongkorn Memorial Hospital, Bangkok. From the early to mid-1990s, an epidemic wave of HIV-infected women and infants occurred. Heterosexual HIV transmission, as described in the Asian Epidemic Model, was the major mode of spread in Thailand, causing an increasing number of HIV-infected pregnant women. The early and concerted multi-sectoral response of Thai society reduced the prevalence of HIV infection in pregnant women from 2% in the mid-1990s to 0.6% in 2015 and mother-to-child transmission of HIV (MTCT) from an estimated 20-40% to 1.9%. Thus, Thailand became the first Asian country to achieve the World Health Organization's (WHO) targets for the elimination of MTCT. In this narrative review, the key historic evolutions of the science and policy of prevention of mother-to-child transmission of HIV (PMTCT) in Thailand that addressed the four prongs of the recommended WHO PMTCT strategy are described, and the lessons learned are discussed.
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Key Words
- AEM, Asian Epidemic Model
- ANC, antenatal care
- ART, anti-retroviral therapy
- Asian epidemic model
- CDC, communicable disease control
- CMR, child mortality rate
- EID, early infant diagnosis
- EPP, Estimation and Projection Package
- FSW, female commercial sex worker
- HAART, highly active anti-retroviral therapy
- HIV
- HSM, heterosexual men
- IDU, intravenous drug users
- MOPH, Ministry of Public Health
- NGO, non-government organisation
- PACTG, Paediatric AIDS Clinical Trials Group
- PCR, polymerase chain reaction
- PHIMS, Perinatal HIV Intervention Monitoring System
- PHOMS, Perinatal HIV Outcome Monitoring System
- PLWHA, people living with HIV/AIDS
- PROM, premature rupture of membranes
- STI, sexually transmitted infection
- TDR, triple-drug regimen
- TRCS, Thai Red Cross Society
- Thailand
- WLWHA, women living with HIV/AIDS
- elimination
- mother-to-child
- policy
- transmission
- vertical
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Liu ZY, Li J, Hong Y, Yao L. Reproductive health service utilization and social determinants among married female rural-to-urban migrants in two metropolises, China. ACTA ACUST UNITED AC 2016; 36:904-909. [PMID: 27924513 DOI: 10.1007/s11596-016-1682-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 10/14/2016] [Indexed: 10/18/2022]
Abstract
Reproductive health (RH) education and services of female migrants in China have become an important health issue. This research aimed to investigate the RH knowledge and utilization among married female migrants, and to explore the influencing factors from the perspectives of population and sociology. We conducted a cross-section survey in Shenzhen and Wuhan, China, using the purposive sampling method. A total of 1021 rural-to-urban married migrants were recruited, with 997 valid survey results obtained. A face-to-face structured questionnaire survey was used, with primary focus on knowledge of fertility, contraception, family planning policy and sexual transmitted diseases/acquired immunodeficiency syndrome (STD/AIDs), and RH service utilization. The results showed that the RH service utilization (38.0%) was at a low level in married migrants and the accessibility of RH service was poor. Females who migrated to (OR=0.32) Wuhan obtained fewer RH consultations than those in Shenzhen. The workers with high school education received additional RH consultations and checkup services than those with other background education, apart from the white collar workers who received extra RH consultations and checkup services than the blue collar workers (P<0.05). We can draw a conclusion that the utilization of RH services in married female migrants remains at a low level in China. RH service utilization can be improved via the relevant health departments by enhancing the responsibility of maternal and health care in the community health service center.
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Affiliation(s)
- Zhi-Yong Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Jiang Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yang Hong
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Lan Yao
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
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Diamond-Smith N, Thet MM, Khaing EE, Sudhinaraset M. Delivery and postpartum practices among new mothers in Laputta, Myanmar: intersecting traditional and modern practices and beliefs. CULTURE, HEALTH & SEXUALITY 2016; 18:1054-1066. [PMID: 27212423 DOI: 10.1080/13691058.2016.1144792] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Myanmar is witnessing increased access to modern maternity care, along with shifting norms and practices. Past research has documented low rates of facility-based deliveries in the country, along with adverse maternal and child health outcomes. Research has also documented diverse traditional practices in the postpartum period, related to maternity care and maternal food intake. Through 34 qualitative interviews with women who recently gave birth and their mothers-in-law in one township in Myanmar (Laputta), we explore factors influencing decision-making around postpartum care and the practices that women engage in. We find that women use both modern and traditional providers because different types of providers play particular roles in the delivery and postpartum period. Despite knowledge of about healthy foods to eat postpartum, many women restrict the intake of certain foods, and mothers-in-laws' beliefs in these practices are particularly strong. Findings suggest that women and their families are balancing two different sets of practices and beliefs, which at times come in conflict. Educational campaigns and programmes should address both modern and traditional beliefs and practices to help women be better able to access safe care and improve their own and their children's health.
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Affiliation(s)
- Nadia Diamond-Smith
- a Global Health Group/UCSF Global Health Sciences , University of California , San Francisco , USA
| | - May Me Thet
- b Population Services International , Yangon , Myanmar
| | - Ei Ei Khaing
- b Population Services International , Yangon , Myanmar
| | - May Sudhinaraset
- a Global Health Group/UCSF Global Health Sciences , University of California , San Francisco , USA
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Kamal N, Curtis S, Hasan MS, Jamil K. Trends in equity in use of maternal health services in urban and rural Bangladesh. Int J Equity Health 2016; 15:27. [PMID: 26883742 PMCID: PMC4756462 DOI: 10.1186/s12939-016-0311-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 02/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal healthcare utilization is a major determinant of maternal mortality. Bangladesh is experiencing a rapid pace of urbanization with all future growth in population expected to be in urban areas. Health care infrastructure is different in urban and rural areas thus warranting an examination of equity in use rates of maternal healthcare. This paper addresses whether the urban-rural and rich-poor gaps in use of selected maternal healthcare indicators have narrowed or widened over the last decade. The paper also explores changes in the service provider environment in urban and rural domains. METHODS The 2001 and 2010 Bangladesh Maternal Mortality and Health Care Survey data were used to examine trends in use of antenatal care from medically trained providers and in deliveries taking place at health facilities. Separate wealth quintiles were constructed for urban and rural areas. The concentration index was calculated for urban and rural areas to measure equity in distribution of antenatal care (ANC) and facility deliveries across wealth quintiles in urban and rural domains. RESULTS The gap in use of ANC provided by medically trained personnel narrowed in urban and rural areas between 2001 and 2010 while that in facility deliveries widened. The difference in use of ANC by the rich and the poor was not as pronounced as that in utilization of facilities for deliveries. Over the last decade, equity in utilization of health facilities for deliveries has improved at a faster rate in urban areas. Private sector has surpassed the public sector and appears to be the dominant provider of maternal healthcare in both domains with the share of NGOs increasing in urban areas. CONCLUSIONS The faster pace of improvement in equity in maternal healthcare utilization in urban areas is reflective of the changing service environment in urban and rural areas, among other factors.
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Affiliation(s)
- Nahid Kamal
- MEASURE Evaluation, University of North Carolina at Chapel Hill, Chapel Hill, USA. .,Seconded to International Center for Diarrheal Disease Research (icddr,b), Dhaka, Bangladesh.
| | - Sian Curtis
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Mohammad S Hasan
- Department of Population Sciences, University of Dhaka, Dhaka, Bangladesh.
| | - Kanta Jamil
- Office of Population, Health, Nutrition and Education, USAID, Dhaka, Bangladesh.
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Thai health care provider knowledge of neonatal male circumcision in reducing transmission of HIV and other STIs. BMC Health Serv Res 2015; 15:520. [PMID: 26607066 PMCID: PMC4660842 DOI: 10.1186/s12913-015-1182-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 11/18/2015] [Indexed: 12/31/2022] Open
Abstract
Background Male circumcision (MC) reduces the risk of female-to-male transmission of HIV and other sexually transmitted infections (STIs). MC has not been practiced as a disease prevention measure in Thailand probably because of low recognition of its benefits among stakeholders. Neonatal male circumcision (NMC) is simpler, safer and cheaper than adult MC. This study aimed to assess Thai health care provider knowledge of benefits implementing NMC in Thailand. Methods Multi-stage sampling identified 16 government hospitals to represent various hospital sizes and regions of the country. Researchers administered a fixed choice questionnaire, developed by the research team based on a previous study, to physician administrators, practicing physicians, and nurses whose jobs involved NMC clinical procedures or oversight. The participants reviewed printed educational materials on the benefits of NMC during questionnaire completion. Data were analyzed using descriptive statistics, chi square tests, odds ratios, and logistic regression. Results One hundred thirty-three individuals participated in this quantitative study. Only 38 % of the participants agreed that NMC reduced the risk of sexual transmission of HIV while 65 % indicated that they knew that NMC prevented STIs. Most participants recognized the benefits of NMC on hygiene (96 %) as well as cancer prevention (74 %). Major concerns raised were potential trauma to the child, child rights and safety of NMC. After reviewing written information about the benefits of NMC, 59 % of the participants agreed that NMC should be offered in their hospital. Physicians and nurses who had previous experience with circumcising patients of all ages were more reluctant to have NMC performed in their hospital. Conclusions A clear policy advocating NMC, thorough preparation of health facilities, and staff training are needed before NMC could be used in Thailand as prevention strategy for HIV and other STIs.
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Afraid of Delivering at the Hospital or Afraid of Delivering at Home: A Qualitative Study of Thai Hmong Families’ Decision-Making About Maternity Services. Matern Child Health J 2015; 19:2384-92. [DOI: 10.1007/s10995-015-1757-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Accelerating health equity: the key role of universal health coverage in the Sustainable Development Goals. BMC Med 2015; 13:101. [PMID: 25925656 PMCID: PMC4415234 DOI: 10.1186/s12916-015-0342-3] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 04/01/2015] [Indexed: 11/10/2022] Open
Abstract
The Sustainable Development Goals (SDGs), to be committed to by Heads of State at the upcoming 2015 United Nations General Assembly, have set much higher and more ambitious health-related goals and targets than did the Millennium Development Goals (MDGs). The main challenge among MDG off-track countries is the failure to provide and sustain financial access to quality services by communities, especially the poor. Universal health coverage (UHC), one of the SDG health targets indispensable to achieving an improved level and distribution of health, requires a significant increase in government investment in strengthening primary healthcare - the close-to-client service which can result in equitable access. Given the trend of increased fiscal capacity in most developing countries, aiming at long-term progress toward UHC is feasible, if there is political commitment and if focused, effective policies are in place. Trends in high income countries, including an aging population which increases demand for health workers, continue to trigger international migration of health personnel from low and middle income countries. The inspirational SDGs must be matched with redoubled government efforts to strengthen health delivery systems, produce and retain more and relevant health workers, and progressively realize UHC.
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Fried ST, Khurshid A, Tarlton D, Webb D, Gloss S, Paz C, Stanley T. Universal health coverage: necessary but not sufficient. REPRODUCTIVE HEALTH MATTERS 2015; 21:50-60. [PMID: 24315063 DOI: 10.1016/s0968-8080(13)42739-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In this article, we highlight key considerations for better addressing sexual and reproductive health and rights issues within universal health coverage (UHC), particularly in the context of the post-2015 sustainable development agenda. We look at UHC as a health, development and health care financing issue, and its history. We discuss its limitations as currently understood from a human rights perspective, and show why structural barriers to health and the legal and policy environment, which are essential to health (particularly to sexual and reproductive health and rights), require critical consideration in current discussions about health in the post-2015 development framework and must be taken into account above and beyond UHC in any future health goal. As a result, we suggest that UHC alone will not result in universal access to sexual and reproductive health, and certainly not to sexual and reproductive rights. Instead, it should be considered as a means to achieving broader health and development goals. A goal such as seeking to reach the highest attainable standard of health or maximizing healthy lives that is informed by a rights-based approach should be the aspiration for the post-2015 development agenda.
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Affiliation(s)
- Susana T Fried
- Deputy Cluster Leader and Senior Gender, HIV and Health Advisor, Mainstreaming, Gender and the MDGs, HIV, Health and Development Group, Bureau for Development Policy, United Nations Development Programme (UNDP), New York, NY, USA.
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Tangcharoensathien V, Chaturachinda K, Im-em W. Commentary: Thailand: sexual and reproductive health before and after universal health coverage in 2002. Glob Public Health 2014; 10:246-8. [PMID: 25524152 PMCID: PMC4318085 DOI: 10.1080/17441692.2014.986166] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Levy JK, Curtis S, Zimmer C, Speizer IS. Assessing gaps and poverty-related inequalities in the public and private sector family planning supply environment of urban Nigeria. J Urban Health 2014; 91:186-210. [PMID: 24248622 PMCID: PMC3907627 DOI: 10.1007/s11524-013-9841-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Nigeria is the most populous country in Africa, and its population is expected to double in <25 years (Central Intelligence Agency 2012; Fotso et al. 2011). Over half of the population already lives in an urban area, and by 2050, that proportion will increase to three quarters (United Nations, Department of Economic and Social Affairs, Population Division 2012; Measurement Learning & Evaluation Project, Nigerian Urban Reproductive Health Initiative, National Population Commission 2012). Reducing unwanted and unplanned pregnancies through reliable access to high-quality modern contraceptives, especially among the urban poor, could make a major contribution to moderating population growth and improving the livelihood of urban residents. This study uses facility census data to create and assign aggregate-level family planning (FP) supply index scores to 19 local government areas (LGAs) across six selected cities of Nigeria. It then explores the relationships between public and private sector FP services and determines whether contraceptive access and availability in either sector is correlated with community-level wealth. Data show pronounced variability in contraceptive access and availability across LGAs in both sectors, with a positive correlation between public sector and private sector supply environments and only localized associations between the FP supply environments and poverty. These results will be useful for program planners and policy makers to improve equal access to contraception through the expansion or redistribution of services in focused urban areas.
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Affiliation(s)
- Jessica K Levy
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA,
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Embedding sexual and reproductive health and rights in a transformational development framework: lessons learned from the MDG targets and indicators. REPRODUCTIVE HEALTH MATTERS 2013; 21:74-85. [DOI: 10.1016/s0968-8080(13)42727-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Srithanaviboonchai K, Grimes RM, Suwanteerankul J, Thaikla K, Korana J, Pruenglampoo B. Capability of Thailand to implement newborn male circumcision: a nation-wide survey. AIDS Care 2013; 26:20-5. [PMID: 23656295 DOI: 10.1080/09540121.2013.793280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study was designed to gain baseline information on the capability of the hospitals of Thailand to provide newborn male circumcision (NC) and on the opinions of health-care personnel towards NC. Two questionnaires were sent to every hospital in Thailand that might have obstetrical services. One questionnaire requested information about the degree to which NC was provided by the hospital. The second questionnaire targeted health-care providers' opinions about NC. The response rate was 55.1% (747/1355). Of the 562 hospitals that had deliveries in 2010, 8.2% (46) provided at least one NC. Thirty-eight percent (35/92) of private hospitals and 2.3% (11/470) of government hospitals provided the service. The primary reason for performing NC was parental request (82.6%). Some providers (31.3%) said that NC was easy to perform and 39.1% thought NC was safe. Most respondents (91.8%) stated that physicians should perform the procedure instead of nurses, and choices about undergoing NC should be left to parents (55.0%). NC was rarely performed in government hospitals, and its staffs seemed to not recognize the health benefits of NC. A massive education program for health-care providers would be necessary before implementing a national program for NC. More information on the opinions of health authorities, health-care personnel and parents as well as cost-effectiveness studies are needed before a proper policy can be implemented.
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Does the developmental plasticity hypothesis have application to Irish Travellers? Findings from the all Ireland Traveller Health Study birth cohort 2008–2011. J Dev Orig Health Dis 2013; 4:307-16. [DOI: 10.1017/s2040174413000160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There is little record of birth weight of Irish Travellers, a minority group in Ireland. Travellers are known to have higher rate of adult chronic disease and to be exposed to life-long disadvantage. The aim of this study was to establish whether the birth weight and infant mortality rate patterns in Ireland's Travellers were consistent with the developmental plasticity hypothesis. A 1-year follow-up birth cohort study was conducted with linkage data from maternity hospital records of Traveller infants born on the island of Ireland over a 12-month period to self-identifying Traveller and general Irish population mothers from the Lifeways Cross-Generation Cohort Study. The main outcome measure was the rate of birth weight <3000 g in a cohort of Traveller children. There were 987 confirmed Traveller births, 500 of whose mothers consented to linkage to their records. A social gradient was observed in the distribution of birth weight in the general population and Traveller infants constituted the highest proportion of all social classes in the birth weight range of 3 kg or less (16.3%). There was a high rate of persistent smoking among Traveller mothers (53%). After adjustment for smoking and alcohol consumption in pregnancy, the birth weight differential persisted (OR 3.5, 95% CI 1.4–8.1). Infant mortality rate at 12.0/1000 births (95% CI 5.5–19.7) was almost four times that of the general population. This analysis confirms Travellers had a greater than expected incidence of low birth weight and high infant mortality with high rates of premature adult chronic diseases from all causes already demonstrated previously.
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Youngwanichsetha S. Factors related to exclusive breastfeeding among postpartum Thai women with a history of gestational diabetes mellitus. J Reprod Infant Psychol 2013. [DOI: 10.1080/02646838.2012.755733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Nikiema B, Haddad S, Potvin L. Measuring women's perceived ability to overcome barriers to healthcare seeking in Burkina Faso. BMC Public Health 2012; 12:147. [PMID: 22369583 PMCID: PMC3353158 DOI: 10.1186/1471-2458-12-147] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 02/27/2012] [Indexed: 11/12/2022] Open
Abstract
Background In sub-Saharan Africa, women must overcome numerous barriers when they need modern healthcare. Respect of gender norms within the household and the community may still influence women's ability to obtain care. A lack of gender-sensitive instruments for measuring women's ability to overcome barriers compromises attempts to adequately quantify the burden and risk of exclusion they face when seeking modern healthcare. The aim of this study was to create and validate a synthetic measure of women's access to healthcare from a publicly available and possibly internationally comparable population-based survey. Method Seven questionnaire items from the Burkina Faso 2003 DHS were combined to create the index. Cronbach's alpha coefficient was used to test the reliability of the index. Exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) were applied to evaluate the factorial structure and construct validity of the index while taking into account the hierarchical structure of the data. Results The index has a Cronbach's alpha of 0.75, suggesting adequate reliability. In EFA, three correlated factors fitted the data best. In CFA, the construct of perceived ability to overcome barriers to healthcare seeking emerged as a second-order latent variable with three domains: socioeconomic barriers, geographical barriers and psychosocial barriers. Model fit indices support the index's global validity for women of reproductive age in Burkina Faso. Evidence for construct validity comes from the finding that women's index scores increase with household living standard. Conclusion The DHS items can be combined into a reliable and valid, gender-sensitive index quantifying reproductive-age women's perceived ability to overcome barriers to healthcare seeking in Burkina Faso. The index complies conceptually with the sector-cross-cutting capability approach and enables measuring directly the perceived access to healthcare. Therefore it can help to improve the design and evaluation of interventions that aim to facilitate healthcare seeking in this country. Further analyses may examine how far the index applies to similar contexts.
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Affiliation(s)
- Béatrice Nikiema
- Département de Médecine Sociale et Préventive, Université de Montréal, CP 6128 Succ, Centre-Ville, Montréal, Québec H3C 3J7, Canada.
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Fonn S, Sundari Ravindran TK. The macroeconomic environment and sexual and reproductive health: a review of trends over the last 30 years. REPRODUCTIVE HEALTH MATTERS 2011; 19:11-25. [DOI: 10.1016/s0968-8080(11)38584-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Liabsuetrakul T, Oumudee N. Effect of health insurance on delivery care utilization and perceived delays and barriers among southern Thai women. BMC Public Health 2011; 11:510. [PMID: 21711550 PMCID: PMC3142511 DOI: 10.1186/1471-2458-11-510] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 06/28/2011] [Indexed: 01/31/2023] Open
Abstract
Background Financial reform aims to overcome the problems of financial barriers and utilization of health services. However, it is unclear whether financial reforms or health insurance can reduce delays and/or barriers or if there are still other important obstacles for preventing pregnant women accessing delivery care. This study aimed to assess the effect of health insurance and other factors on delivery care utilization and the perception of delays and barriers to delivery care among women living in Songkhla province, Thailand. Methods A cross-sectional study was conducted from November 2007 to December 2008. Women who delivered at hospital or home in the areas of participating hospitals in four districts were interviewed at 24- or 48-hours postpartum. The impact of health insurance and other factors on outcomes of interest was assessed using multivariate logistic regression. Results Of 2,847 women, 2,822 delivered at a hospital and 25 at home, of which 80% and 40% had health insurance for delivery care, respectively. Muslims, low educated women, those who thought they could not use health insurance for delivery care and those less willing to seek care at their delivery place were more likely to give birth at home. Perception of delays to seeking care, reaching a hospital and receiving care was reduced in women insured by civil servant medical benefit. Women insured by universal coverage and social security perceived a lower delay in reaching a hospital but a higher delay in receiving care. Low education, unwillingness to seek care, out-of-pocket payment, worry about cost of delivery care, transportation difficulties, low perception of receiving good care or a perception of being treated badly were also associated with delays and barriers to health care. Almost all (93%) agreed that health insurance could reduce financial barriers for accessing services. However, having health insurance influenced them to seek care, reach a hospital, and receive care quickly in 50%, 32%, and 23% of the women, respectively. Conclusions Health insurance has a significant impact on perceived delays and barriers, but not place of delivery. Socio-economic determinants continue to play an important role for place of delivery and perceived delays and barriers.
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Affiliation(s)
- Tippawan Liabsuetrakul
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand.
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