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Al-Zubayer MA, Shanto HH, Kundu S, Sarder MA, Ahammed B. The level of utilization and associated factors of WHO recommended antenatal care visits in South Asian countries. DIALOGUES IN HEALTH 2024; 4:100175. [PMID: 38516215 PMCID: PMC10953919 DOI: 10.1016/j.dialog.2024.100175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/26/2024] [Accepted: 02/23/2024] [Indexed: 03/23/2024]
Abstract
Background Antenatal care can play an important role in reducing the death of both mothers and children. This study was designed to find out the determinants of world health organization recommended antenatal care visits in six South Asian countries to achieve the targets for Sustainable Development Goal. Methods This study used recent demographic and health survey data from six South Asian countries such as Afghanistan (2015), Bangladesh (2017-18), India (2015-16), Maldives (2016-17), Nepal (2016), and Pakistan (2047-18). Descriptive statistics were calculated for the distribution and prevalence of antenatal care visits. Bivariate and multivariable logistic regressions were used to investigate the influencing factors of antenatal care visits. Results 71,862 women aged 15 to 49 years were included in this study, and 46.64% (95% Confidence Interval = 45.59 - 47.69%) had world health organization recommended antenatal care visits. In the pooled data, urban women (AOR ([Adjusted Odds Ratio]=1.48; 95% CI [Confidence Interval]=1.33-1.66), richest family (AOR=1.48; 95% CI=1.25-1.76), women's higher education (AOR=3.76; 95% CI=3.33-4.25), women's partner/husband's higher education (AOR=1.69; 95% CI=1.50-1.92), 35-49 years (AOR=1.25, 95% CI=1.11-1.42), women's age at first birth >25 years (AOR=1.51, 95% CI=1.36-1.68) and fully media exposure (AOR=2.11; 95% CI=1.74-2.56) were significantly positively associated with WHO recommended antenatal care visits. Whereas, working women (AOR=0.82; 95% CI=0.76-0.88), healthcare decision maker by their husband/others (AOR=0.71, 95% CI=0.60-0.84), ≥7 children (AOR=0.59; 95% CI=0.50-0.69), and ≥7 family members (AOR=0.82; 95% CI=0.73-0.93) had significant negative effect on antenatal care visits. In country specific analysis, overall, media exposure, secondary and above education of women, ≥25 of years age at first birth, and <4 living children were the key factors of antenatal care visits. Conclusions This study reveals an overall scenario of the WHO-recommended antenatal care visit in South Asian countries, and significant factors related to ANC that we can concentrate onto improve accessibility to healthcare services and promote education and media exposure, especially for rural and less educated women, to increase the prevalence of WHO-recommended antenatal visits in South Asian countries In addition, evidence from this study can be used to assist the policymakers in planning and taking proper steps to increase WHO-recommended antenatal care visits by focusing on the related factors in South Asian countries.
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Affiliation(s)
| | | | - Subarna Kundu
- Statistics Discipline, Khulna University, Khulna-9208, Bangladesh
| | | | - Benojir Ahammed
- Statistics Discipline, Khulna University, Khulna-9208, Bangladesh
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Tumwizere G, K Mbonye M, Ndugga P. Determinants of late antenatal care attendance among high parity women in Uganda: analysis of the 2016 Uganda demographic and health survey. BMC Pregnancy Childbirth 2024; 24:32. [PMID: 38183021 PMCID: PMC10768297 DOI: 10.1186/s12884-023-06214-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 12/19/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Timely and adequate Antenatal Care (ANC) effectively prevents adverse pregnancy outcomes and is crucial for decreasing maternal and neonatal mortality. High-parity women (5 + children) are at higher risk of maternal mortality. Limited information on the late timing of ANC among this risky group continues to hamper Uganda's efforts to reduce maternal mortality ratios and improve infant and child survival. This study aimed to determine factors associated with attendance of the first ANC after 12 weeks of gestation among high-parity women in Uganda. METHODS This study was based on nationally representative data from the 2016 Uganda Demographic and Health Survey. The study sample comprised 5,266 women (aged 15-49) with five or more children. A complementary log-log regression model was used to identify factors associated with late ANC attendance among high-parity women in Uganda. RESULTS Our findings showed that 73% of high parity women delayed seeking their first ANC visit. Late ANC attendance among high-parity women was associated with distance to the health facility, living with a partner, partner's education, delivery in a health facility, and Desire for more children. Women who did not find the distance to the health facility when going for medical help to be a big problem had increased odds of attending ANC late compared to women who found distance a big problem (AOR = 1.113, CI: 1.004-1.234), women not living with partners (AOR = 1.196, 95% CI = 1.045-1.370) having had last delivery in a health facility (AOR = 0.812, 95% CI = 0.709-0.931), and women who desired to have another child (AOR = 0.887, 95% CI = 0.793-0.993) had increased odds compared to their counterparts. CONCLUSIONS To increase mothers' timely attendance and improve maternal survival among high-parity women in Uganda, programs could promote and strengthen health facility delivery and integrate family planning with other services such as ANC and postnatal care education to enable women to seek antenatal care within the recommended first trimester. This study calls for increased support for programs for education, sensitization, and advocacy for health facility-based deliveries. This could be done through strengthened support for VHT and community engagement activities.
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Affiliation(s)
- Godfrey Tumwizere
- School of Statistics and Planning, Makerere University, Kampala, Uganda.
- Action 4 Health Uganda, Kampala, Uganda.
| | - Martin K Mbonye
- School of Statistics and Planning, Makerere University, Kampala, Uganda
| | - Patricia Ndugga
- School of Statistics and Planning, Makerere University, Kampala, Uganda
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Belachew TB, Negash WD, Belay DG, Aragaw FM, Asratie MH, Asmamaw DB. Emergency contraceptive knowledge and associated factors among abortion experienced reproductive age women in Ethiopia: a multilevel analysis using EDHS 2016 data. BMC Pregnancy Childbirth 2023; 23:775. [PMID: 37946102 PMCID: PMC10634145 DOI: 10.1186/s12884-023-06091-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Emergency contraceptives (EC) are used to avoid unintended pregnancy, hence avoiding its incidence and its effects. In Ethiopia, emergency contraception is commonly accessible, especially in the big cities. However, there is virtually little understanding of or awareness of EC and Ethiopia has a high abortion rate. Therefore this study was aimed to assess the magnitude and associated factors for emergency contraceptive knowledge in Ethiopia. METHODS The study was based on secondary data analysis of the Ethiopian Demographic and Health Survey 2016 data. A total weighted sample of 1236 reproductive age women was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors of emergency contraceptive knowledge. Statistical significance was determined using Adjusted Odds Ratio (AOR) with 95% confidence interval. RESULTS Overall magnitude of emergency contraceptive knowledge was observed to be 17.19% (95% CI: 15.18, 19.40) with intra-class correlation (ICC) 57% and median odds ratio (MOR) 6.4 in the null model. Women's age 25-34 (AOR = 2.6; 95% CI: 1.2, 5.5), and 35-49 (AOR = 1.5; 95% CI: 1.06, 3.3), secondary and above educational level (AOR = 3.41; 95% CI: 2.19, 4.88), media exposure (AOR = 2.97; 95% CI: 1.56, 5.64), Being in metropolitan region (AOR = 2.68; 95% CI: 1.46, 4.74), and women being in urban area (AOR = 3.19; 95% CI: 1.20, 5.23) were associated with emergency contraceptive knowledge. CONCLUSION Emergency contraceptive knowledge in this study was low. Women age, educational level, media exposure, residency, and region were significantly associated with emergency contraceptive knowledge. Therefore, to enhance understanding and use of ECs in the current Ethiopian setting, it is imperative to ensure exposure to EC information, particularly in rural regions.
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Affiliation(s)
- Tadele Biresaw Belachew
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Wubshet Debebe Negash
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melaku Hunie Asratie
- Department of Women's and Family health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Sabet F, Prost A, Rahmanian S, Al Qudah H, Cardoso MN, Carlin JB, Sawyer SM, Patton GC. The forgotten girls: the state of evidence for health interventions for pregnant adolescents and their newborns in low-income and middle-income countries. Lancet 2023; 402:1580-1596. [PMID: 37837988 DOI: 10.1016/s0140-6736(23)01682-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 03/06/2023] [Accepted: 08/09/2023] [Indexed: 10/16/2023]
Abstract
Every year, an estimated 21 million girls aged 15-19 years become pregnant in low-income and middle-income countries (LMICs). Policy responses have focused on reducing the adolescent birth rate whereas efforts to support pregnant adolescents have developed more slowly. We did a systematic review of interventions addressing any health-related outcome for pregnant adolescents and their newborn babies in LMICs and mapped its results to a framework describing high-quality health systems for pregnant adolescents. Although we identified some promising interventions, such as micronutrient supplementation, conditional cash transfers, and well facilitated group care, most studies were at high risk of bias and there were substantial gaps in evidence. These included major gaps in delivery, abortion, and postnatal care, and mental health, violence, and substance misuse-related outcomes. We recommend that the fields of adolescent, maternal, and sexual and reproductive health collaborate to develop more adolescent-inclusive maternal health care and research, and specific interventions for pregnant adolescents. We outline steps to develop high-quality, evidence-based care for the millions of pregnant adolescents and their newborns who currently do not receive this.
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Affiliation(s)
- Farnaz Sabet
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
| | - Audrey Prost
- Institute for Global Health, University College London, London, UK
| | | | - Heba Al Qudah
- Department of Diagnostic Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mauro Nogueira Cardoso
- Coletivo da Saude, Research Group in Public Health, Pontifical Catholic University of Minas Gerais, Minas Gerais, Brazil
| | - John B Carlin
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Susan M Sawyer
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - George C Patton
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
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McCarthy KJ, Blanc AK, Warren CE, Bajracharya A, Bellows B. Exploring the accuracy of self-reported maternal and newborn care in select studies from low and middle-income country settings: do respondent and facility characteristics affect measurement? BMC Pregnancy Childbirth 2023; 23:448. [PMID: 37328744 DOI: 10.1186/s12884-023-05755-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 06/02/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Accurate data on the receipt of essential maternal and newborn health interventions is necessary to interpret and address gaps in effective coverage. Validation results of commonly used content and quality of care indicators routinely implemented in international survey programs vary across settings. We assessed how respondent and facility characteristics influenced the accuracy of women's recall of interventions received in the antenatal and postnatal periods. METHODS We synthesized reporting accuracy using data from a known sample of validation studies conducted in Sub-Saharan Africa and Southeast Asia, which assessed the validity of women's self-report of received antenatal care (ANC) (N = 3 studies, 3,169 participants) and postnatal care (PNC) (N = 5 studies, 2,462 participants) compared to direct observation. For each study, indicator sensitivity and specificity are presented with 95% confidence intervals. Univariate fixed effects and bivariate random effects models were used to examine whether respondent characteristics (e.g., age group, parity, education level), facility quality, or intervention coverage level influenced the accuracy of women's recall of whether interventions were received. RESULTS Intervention coverage was associated with reporting accuracy across studies for the majority (9 of 12) of PNC indicators. Increasing intervention coverage was associated with poorer specificity for 8 indicators and improved sensitivity for 6 indicators. Reporting accuracy for ANC or PNC indicators did not consistently differ by any other respondent or facility characteristic. CONCLUSIONS High intervention coverage may contribute to higher false positive reporting (poorer specificity) among women who receive facility-based maternal and newborn care while low intervention coverage may contribute to false negative reporting (lower sensitivity). While replication in other country and facility settings is warranted, results suggest that monitoring efforts should consider the context of care when interpreting national estimates of intervention coverage.
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Affiliation(s)
- Katharine J McCarthy
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Blavatnik Women's Health Research Institute, New York, NY, USA.
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Envuladu EA, Issaka AI, Dhami MV, Sahiledengle B, Agho KE. Differential Associated Factors for Inadequate Receipt of Components and Non-Use of Antenatal Care Services among Adolescent, Young, and Older Women in Nigeria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20054092. [PMID: 36901102 PMCID: PMC10001685 DOI: 10.3390/ijerph20054092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 02/21/2023] [Accepted: 02/21/2023] [Indexed: 05/10/2023]
Abstract
Nigerian women continue to die in childbirth due to inadequate health services such as antenatal care (ANC). Among other factors, the inadequate receipt or non-use of ANC appears to be associated with the age of women, remoteness, and poor households. This cross-sectional study aimed to compare the factors associated with inadequate receipt of the components and non-use of ANC among pregnant adolescents, and young and older women in Nigeria. Data for this study were from the 2018 Nigeria Demographic and Health Survey (NDHS) and covered a weighted total of 21,911 eligible women. Survey multinomial logistic regression analyses that adjusted for cluster, and survey weights were conducted to examine factors associated with adolescent, young, and older women. Adolescent women reported a higher prevalence of inadequate receipts and non-use of ANC than young and older women. Increased odds of inadequate receipt of the components of ANC were associated with residence in the North-East region and rural areas for all three categories of women. For adolescent women, the increased odds of inadequate receipt of the components of ANC were associated with delivering a baby at home and a big problem with distance to health facilities. Limited education or no schooling was associated with the increased odds of receiving inadequate ANC among older women. Implementing interventions to improve maternal and child health care should focus on the factors associated with the increased odds of receipt of inadequate or non-use of ANC services among Nigerian adolescent women, particularly those living in rural areas in the North-East region.
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Affiliation(s)
- Esther Awazzi Envuladu
- Department of Community Medicine, College of Health Sciences, University of Jos, Jos 930003, Nigeria
| | - Abukari Ibrahim Issaka
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Mansi Vijaybhai Dhami
- The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW 2571, Australia
| | - Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba 4540, Ethiopia
| | - Kingsley Emwinyore Agho
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW 2571, Australia
- African Vision Research Institute, Westville Campus, University of KwaZulu-Natal, Durban 3629, South Africa
- Correspondence: ; Tel.: +61-2-4620-3635
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Traore SS, Bo Y, Kou G, Lyu Q. Iron supplementation and deworming during pregnancy reduces the risk of anemia and stunting in infants less than 2 years of age: a study from Sub-Saharan Africa. BMC Pregnancy Childbirth 2023; 23:63. [PMID: 36698082 PMCID: PMC9875517 DOI: 10.1186/s12884-023-05399-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND In sub-Saharan Africa, infant anemia, stunting and low birth weight remains major public health problems. It is unclear whether prenatal iron supplementation and/or deworming can reduce the risk of infant stunting, anemia and low birth weight. The aim of this study was to investigate the relationship between iron supplementation and/or deworming and stunting, anemia, and low birth weight in infants under two years of age in sub-Saharan Africa. METHODS Our studies examined pooled data from Demographic and Health Surveys (DHS) in twenty-three African countries collected between 2014 and 2020. childhood anemia and stunting in infants under the age of two were the primary outcomes. Iron supplementation and deworming during prenatal visits were the main exposure variables. A multivariate logistic regression model was used to investigate these relationships. RESULTS The prevalence of stunting was 29.9%, severe stunting was 10.6%, childhood anemia was 74.3%, childhood severe anemia was 3.2%, and low birth weight was 16.4%, respectively. The use of prenatal iron supplementation alone was associated with a significant reduction of childhood anemia [aOR (95% CI) = 0.9 (0.8-1.0)]. Prenatal deworming alone was associated with a significantly reduced risk of stunting [aOR (95% CI) = 0.7 (0.8-1.0)], childhood anemia [aOR (95% CI) = 0.7 (0.8-0.9)], and low birth weight [aOR (95% CI) = 0.7 (0.8-1.0)]. Prenatal iron supplementation plus deworming or iron supplementation (with or without deworming) were not associated with childhood anemia, infant stunting and low birth weight. CONCLUSIONS In Sub-Saharan Africa, prenatal deworming alone has the potential to improve infants' outcomes. Childhood anemia was improved with prenatal iron supplementation alone. Our recent findings indicate the necessity for prospective studies on the association between prenatal iron supplementation plus deworming and childhood anemia, stunting and low birth weight.
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Affiliation(s)
- Stanislav Seydou Traore
- grid.207374.50000 0001 2189 3846Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, 450001 China
| | - Yacong Bo
- grid.10784.3a0000 0004 1937 0482Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, 999077 China
| | - Guangning Kou
- grid.207374.50000 0001 2189 3846Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, 450001 China ,grid.207374.50000 0001 2189 3846Centre of Sport Nutrition and Health, School of Physical Education, Zhengzhou University, Zhengzhou, 450001 China
| | - Quanjun Lyu
- grid.207374.50000 0001 2189 3846Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, 450001 China ,grid.412633.10000 0004 1799 0733Department of Nutrition, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 China
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Osanyin GE, Bankethomas A, Oluwole EO, Odeseye AK, Afolabi BB. Effects of a mHealth voice messaging intervention on antenatal care utilisation at primary care level in Lagos, Nigeria: a cluster randomised trial. J Public Health Afr 2022; 13:2222. [PMID: 36277941 PMCID: PMC9585595 DOI: 10.4081/jphia.2022.2222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Nigeria has one of the lowest antenatal care (ANC) utilization rates compared to other low- and middle-income nations. In order to ensure a positive pregnant experience, the World Health Organization recommends at least eight ANC visits during pregnancy. This study intends to examine the impact of a mobile phone-based voice message intervention on ANC use in Lagos, Nigeria. Methods In this cluster-randomized experiment, primary healthcare centres were divided into five intervention and five control groups using multistage simple random sampling. The intervention consisted of a weekly voice message transmitted through mobile phone from the time of recruitment in the first trimester until two weeks postpartum. Attending at least eight ANC visits before birth was the primary outcome. STATA v17.0 was used to conduct descriptive and bivariate analyses as well as multivariate linear models to calculate crude risk ratios. Results 458 women participated. All intervention group women (269 women, or 58.7% of the sample) received the text message. These ladies were mostly married, Christian, had several children, and had completed high school. Women who received the intervention were more likely to attend eight ANC visits. Conclusion A voice message-based intervention can boost ANC utilization, according to the conclusion. This contributes to the existing body of information about the influence of mHealth treatments on maternal health outcomes and serves as a useful tool for ensuring that no woman is left behind.
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Moucheraud C, McBride K, Heuveline P, Shah M. Preventing, but Not Caring for, Adolescent Pregnancies? Disparities in the Quality of Reproductive Health Care in Sub-Saharan Africa. J Adolesc Health 2022; 71:210-216. [PMID: 35437221 PMCID: PMC9995166 DOI: 10.1016/j.jadohealth.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE There is concern that adolescents experience worse quality of health care than older women. We compare quality of reproductive health services (family planning and antenatal care) for adolescents (<20 years) versus adult women (≥25 years), in four sub-Saharan African countries. METHODS In total, 2,342 family planning visits and 8,600 antenatal care visits were analyzed from Democratic Republic of the Congo, Malawi, Senegal, and Tanzania. Service Provision Assessment surveys include observation of care and client exit interviews. We compare visit content and care satisfaction for adolescents versus adult women aged ≥25. All models are multilevel, weighted to reflect survey design, and include client, provider, and facility covariates (pooled models also include survey fixed effects). RESULTS Adolescents receive more overall family planning care activities compared to adult women (2.31 activities in adjusted generalized linear models, standard error [SE] 1.29, p < .1), and 3.76 more discussion activities (e.g., counseling) on average (SE 1.94, p < .1), but significantly fewer discussion activities during antenatal care (-3.10 activities, SE .97, p < .01). However, adolescents' satisfaction with both care types was not significantly different than adult women. These relationships largely persist in country-stratified models, using different model specifications, and when comparing adolescents to women aged ≥20. CONCLUSIONS Adolescents' family planning visits are similar to, or even slightly more comprehensive than, adult women-but their antenatal visits include fewer recommended care components, with particular gaps for activities requiring provider-client dialog. This suggests opportunities for strengthening communication between providers and young women, and improving care across the reproductive health continuum.
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Affiliation(s)
- Corrina Moucheraud
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California; UCLA Center for Health Policy Research, Los Angeles, California.
| | - Kaitlyn McBride
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Patrick Heuveline
- Department of Sociology and California Center for Population Research, University of California Los Angeles, Los Angeles, California
| | - Manisha Shah
- Department of Public Policy, Luskin School of Public Affairs, University of California Los Angeles, Los Angeles, California
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Anaba EA, Afaya A. Correlates of late initiation and underutilisation of the recommended eight or more antenatal care visits among women of reproductive age: insights from the 2019 Ghana Malaria Indicator Survey. BMJ Open 2022; 12:e058693. [PMID: 35793917 PMCID: PMC9260762 DOI: 10.1136/bmjopen-2021-058693] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 06/21/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE This study assessed the correlates of late initiation and underutilisation of the WHO's recommended eight or more antenatal care visits among women in Ghana. DESIGN We analysed secondary data from 2163 women in the 2019 Ghana Malaria Indicator Survey, which collected data on malaria and antenatal care indicators among women of reproductive age across the previous 10 regions of Ghana. SETTING AND PARTICIPANTS Women of reproductive age across the 10 regions of Ghana. MAIN OUTCOME MEASURES Late initiation and underutilisation of the recommended eight or more antenatal care visits among women of reproductive age. RESULTS About half (49%) of the participants were between the ages of 25 and 34 years; mean (±SD)=30 (±7.10). The majority (57%) of the participants obtained less than eight antenatal care visits, while 32% initiated antenatal care visits after the first trimester. The significant factors associated with the late initiation of antenatal care visits were age, region and parity (p<0.05). Factors associated with underutilisation of the recommended eight or more antenatal care visits were marital status, wealth index, parity, region and place of residence (p<0.05). CONCLUSION A majority of the women underused antenatal care services. A significant minority of the women started antenatal care visits late. Socio-demographic factors, parity and socioeconomic factors were identified as the significant factors associated with the late initiation and underutilisation of antenatal care services. Maternal health interventions should prioritise young, multiparous and poor women.
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Affiliation(s)
- Emmanuel Anongeba Anaba
- Department of Population, Family and Reproductive Health, University of Ghana School of Public Health, Accra, Ghana
| | - Agani Afaya
- College of Nursing, Yonsei University, Seodaemun-gu, Seoul, South Korea
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
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Anaba EA, Alor SK, Badzi CD. Utilization of antenatal care among adolescent and young mothers in Ghana; analysis of the 2017/2018 multiple indicator cluster survey. BMC Pregnancy Childbirth 2022; 22:544. [PMID: 35790931 PMCID: PMC9254585 DOI: 10.1186/s12884-022-04872-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 06/24/2022] [Indexed: 11/22/2022] Open
Abstract
Background Complications during pregnancy and childbirth are the leading cause of death among adolescent girls. In Ghana, the prevalence of adolescent pregnancy remains high. Yet, little is known about ANC utilization among adolescent and young mothers. This study aimed to assess the prevalence of obtaining 4 or more ANC visits and associated factors among adolescent and young mothers. Methods We analysed secondary data from the sixth round of the Ghana Multiple Indicator Cluster Survey. A total of 947 adolescent and young mothers were included in this study. Data were analysed using STATA/SE, version 16, employing descriptive statistics and Binary Logistic Regression. Results It was found that majority of the participants were aged 20-24 years (70%), married/in union (61%) and non-insured (64%). The prevalence of obtaining 4 or more ANC visits was 84%. Adolescent and young mothers with junior high school education, in the second wealth quintile, exposed to the internet, and resided in the Upper East region had a higher likelihood of obtaining 4 or more ANC visits (p < 0.05). Conclusions This study demonstrated that optimal ANC utilization among adolescent and young mothers were determined by socio-economic factors. Going forward, maternal healthcare interventions must prioritize adolescent and young mothers from poor socio-economic backgrounds.
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Andegiorgish AK, Elhoumed M, Qi Q, Zhu Z, Zeng L. Determinants of antenatal care use in nine sub-Saharan African countries: a statistical analysis of cross-sectional data from Demographic and Health Surveys. BMJ Open 2022; 12:e051675. [PMID: 35149562 PMCID: PMC8845176 DOI: 10.1136/bmjopen-2021-051675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To explore the factors associated with antenatal care (ANC) visits. DESIGN A secondary data analysis from cross-sectional studies was conducted. SETTING Sub-Saharan Africa. PARTICIPANTS 56 002 women aged 15-49 years in Ghana (3224), Kenya (10 981), Malawi (9541), Namibia (2286), Rwanda (4416), Senegal (6552), Tanzania (5536), Uganda (7979) and Zambia (5487) were analysed. OUTCOMES 4+ANC visits. RESULTS Overall, 55.52% (95% CI: 55.11% to 55.93%) of women made 4+ANC visits. The highest 4+ANC visits were in Ghana (85.6%) and Namibia (78.9%), and the lowest were in Senegal (45.3%) and Rwanda (44.5%). Young women 15-19 years had the lowest uptake of 4+ANC visits. Multivariable analysis indicated that the odds of 4+ANC visits were 14% lower among women from rural areas compared with those living in towns (adjusted OR (AOR) 0.86; 95% CI: 0.81 to 0.91). This difference was significant in Kenya, Malawi, Senegal and Zambia. However, in Zambia, the odds of 4+ANC visits were 48% higher (AOR 1.48; 95% CI: 1.2 to 1.82) among women from rural compared with urban areas. Women with higher educational level had more than twofold higher odds of 4+ANC visits in seven of the nine countries, and was significant in Kenya, Malawi, Rwanda and Zambia. Compared with the poorest household wealth category, odds of 4+ANC visits increased by 12%, 18%, 32% and 41% for every 20% variation on the wealth quantile. Women in their first-time pregnancy had higher odds of 4+ANC visits compared with others across all countries, and women who had access to media at least once a week had a 22% higher probability of 4+ANC visits than women who had no access to media (AOR 1.22, 95% CI: 1.15 to 1.29). CONCLUSION The number of ANC visits was considered to be inadequate with substantial variation among the studied countries. Comprehensive interventions on scaling uptake of ANC are needed among the low-performing countries. Particular attention should be given to women of low economic status and from rural areas.
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Affiliation(s)
- Amanuel Kidane Andegiorgish
- Department of Epidemiology and Biostatistics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of Epidemiology and Biostatistics, Asmara College of Health Sciences, Asmara, Eritrea
| | - Mohamed Elhoumed
- Department of Epidemiology and Biostatistics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qi Qi
- Department of Epidemiology and Biostatistics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhonghai Zhu
- Department of Epidemiology and Biostatistics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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13
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Bountogo M, Sié A, Zakané A, Compaoré G, Ouédraogo T, Lebas E, Brogdon J, Nyatigo F, Arnold BF, Lietman TM, Oldenburg CE. Antenatal care attendance and risk of low birthweight in Burkina Faso: a cross-sectional study. BMC Pregnancy Childbirth 2021; 21:825. [PMID: 34903190 PMCID: PMC8667364 DOI: 10.1186/s12884-021-04310-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/01/2021] [Indexed: 11/22/2022] Open
Abstract
Background Low birthweight is a major contributor to infant mortality. We evaluated the association between antenatal care (ANC) attendance and low birthweight among newborns in 5 regions of Burkina Faso. Methods We utilized data from the baseline assessment of a randomized controlled trial evaluating azithromycin distribution during the neonatal period for prevention of infant mortality. Neonates were eligible for the trial if the weighed at least 2500 g at enrollment and were 8–27 days of age. Data on ANC attendance and birthweight was extracted from each child’s carnet de santé, a government-issued health card on which pregnancy and birth-related data are recorded. We used linear and logistic regression models adjusting for potentially confounding variables to evaluate the relationship between ANC attendance (as total number of visits and ≥ 4 antenatal care visits) and birthweight (continuously and categorized into < 2500 g versus ≥2500 g). Results Data from 21,223 births were included in the analysis. The median number of ANC visits was 4 (interquartile range 3 to 5) and 69% of mothers attended at least 4 visits. Mean birthweight was 2998 g (standard deviation 423) and 8.1% of infants were low birthweight (< 2500 g). Birthweight was 63 g (95% CI 46 to 81 g, P < 0.001) higher in newborns born to mothers who had attended ≥4 ANC visits versus < 4 visits. The odds of low birthweight among infants born to mothers with ≥4 ANC visits was 0.71 (95% CI 0.63 to 0.79, P < 0.001) times the odds of low birthweight among infants born to mothers who attended < 4 ANC visits. Conclusions We observed a statistically significant association between ANC attendance and birthweight, although absolute differences were small. Improving access to ANC for all women may help improve birth outcomes. Trial registration The parent trial is registered at clinicaltrials.gov: NCT03682653; first registered 24 September 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04310-6.
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Affiliation(s)
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | | | | | - Elodie Lebas
- Francis I Proctor Foundation, University of California, 490 Illinois St, Floor 2, San Francisco, CA, 94143, USA
| | - Jessica Brogdon
- Francis I Proctor Foundation, University of California, 490 Illinois St, Floor 2, San Francisco, CA, 94143, USA
| | - Fanice Nyatigo
- Francis I Proctor Foundation, University of California, 490 Illinois St, Floor 2, San Francisco, CA, 94143, USA
| | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California, 490 Illinois St, Floor 2, San Francisco, CA, 94143, USA.,Department of Ophthalmology, University of California, San Francisco, USA
| | - Thomas M Lietman
- Francis I Proctor Foundation, University of California, 490 Illinois St, Floor 2, San Francisco, CA, 94143, USA.,Department of Ophthalmology, University of California, San Francisco, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Catherine E Oldenburg
- Francis I Proctor Foundation, University of California, 490 Illinois St, Floor 2, San Francisco, CA, 94143, USA. .,Department of Ophthalmology, University of California, San Francisco, USA. .,Department of Epidemiology and Biostatistics, University of California, San Francisco, USA.
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14
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Awopegba OE, Chukwudeh OS, Owolabi EO, Ajayi AI. Trends in emergency contraception awareness among women and girls in 28 sub-Saharan countries. BMC Public Health 2021; 21:1987. [PMID: 34732160 PMCID: PMC8567620 DOI: 10.1186/s12889-021-12067-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background Studies have shown that emergency contraception (EC) remains underutilised in preventing unintended pregnancy in sub-Saharan Africa (SSA). Small-scale surveys have attributed EC underutilisation to gaps in EC awareness among SSA women and girls. However, limited studies have explored trends in EC awareness in SSA. We address this gap by examining trends in EC awareness using data from 28 SSA countries. Our analysis was disaggregated by age distribution, place of residence, level of education, and wealth to show differences in EC awareness trend. Methods We analysed the Demographic and Health Surveys (DHS) data of 1,030,029 women aged 15 to 49 on emergency contraception awareness. EC awareness was defined as having ever heard of special pills to prevent pregnancy within 3 days after unprotected sexual intercourse. Frequencies and percentages were used to summarise trends in EC awareness between years 2000 and 2019. Results Overall, there was an upward shift in the level of EC awareness in all countries, except in Burkina Faso, Niger, Chad, and Ethiopia. While some countries recorded a significant upward trend in EC awareness, others recorded just a slight increase. Women in Kenya, Ghana, Gabon, and Cameroon had the highest upward shift in EC awareness. For example, only 28% of women were aware of EC in Ghana in 2003, but in 2014, 64% of women knew about EC, an increase of over 36 percentage points. Increase in EC awareness was starker among women aged 20–24 years, those who resided in urban areas, had higher education, and belong to the highest wealth quintile, than those aged 15–19, in rural areas, with no formal education and belonging to the lowest wealth quintile. Conclusion Our analysis shows that the level of EC awareness has increased substantially in most SSA countries. However, EC awareness still differs widely within and between SSA countries. Intervention to improve EC awareness should focus on women aged 15 to 19, those with no formal education, residing in rural areas, and within the lowest quintile, especially, in countries such as Chad, Niger, Burkina Faso, and Ethiopia where level of EC is low with lagging progress. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12067-y.
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Affiliation(s)
- Oluwafemi Emmanuel Awopegba
- Economics and Business Policy Department, Nigerian Institute of Social and Economic Research, Ibadan, Nigeria
| | - Okechukwu Stephen Chukwudeh
- Department of Criminology and Security Studies, Faculty of Social Sciences, Federal University, Oye-Ekiti, Nigeria
| | - Eyitayo Omolara Owolabi
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Centre, APHRC Campus, Manga Close, Nairobi, Kenya.
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15
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Morojele NK, Ramsoomar L, Dumbili EW, Kapiga S. Adolescent health series - Alcohol, tobacco, and other drug use among adolescents in sub-Saharan Africa: A narrative review. Trop Med Int Health 2021; 26:1528-1538. [PMID: 34637175 DOI: 10.1111/tmi.13687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Alcohol, tobacco, and other drug (ATOD) use by adolescents are major contributors to death and disability in sub-Saharan Africa (SSA). This paper reviews the extent of adolescents' ATOD use, risk and protective factors, and studies evaluating prevention interventions for adolescents in SSA. It also describes the harms associated with adolescents' ATOD use in SSA, which mainly include interpersonal violence, sexual risk behaviours, and negative academic outcomes. We use the socio-ecological model as our framework for understanding ATOD use risk and protective factors at individual, interpersonal, peer/school, and societal/structural levels. We used two strategies to find literature evaluating ATOD interventions for adolescents in SSA: (a) we sought systematic reviews of adolescent ATOD interventions in SSA covering the period 2000-2020; and (b) we used a comprehensive evidence review strategy and searched for studies that had evaluated ATOD interventions in all SSA countries between 2000 and 2020. Only two community interventions (a brief intervention and an HIV prevention intervention), out of four that were identified, were partially effective in reducing adolescent ATOD. Furthermore, only one school-based intervention (HealthWise), out of six that we uncovered, had any effect on ATOD use among adolescents. Possible reasons why many interventions were not effective include methodological limitations, involvement of non-evidence-based education-only approaches in some studies, and shortcomings in adaptations of evidence-based interventions. The scale of ATOD and related problems is disproportionate to the number of evaluated interventions to address them in SSA. More ATOD interventions need to be developed and evaluated in well-powered and well-designed studies.
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Affiliation(s)
- Neo K Morojele
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa.,Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Leane Ramsoomar
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa.,School of Public Health and Health Systems, University of the Pretoria, Gauteng, South Africa
| | - Emeka W Dumbili
- Institute for Therapy and Health Research, Kiel, Germany.,Department of Sociology and Anthropology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania.,Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Fatusi A, Riley T, Kayembe PK, Mabika C. Unintended pregnancy, induced abortion and abortion care-seeking experiences among adolescents in Kinshasa, Democratic Republic of Congo: a cross-sectional study. BMJ Open 2021; 11:e044682. [PMID: 34475140 PMCID: PMC8413879 DOI: 10.1136/bmjopen-2020-044682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To estimate age-specific abortion incidence and unintended pregnancy in Kinshasa, Democratic Republic of Congo and compare care experiences between adolescents (15-19 years) and older women (20-49 years). DESIGN We used the age-specific variant of the Abortion Incidence Complications Method to estimate abortion and unintended pregnancy, with data from three primary sources: Health Facility Survey (n=361) provided postabortion care (PAC) caseloads; Prospective Morbidity Survey (n=1031) provided the age distribution and characteristics of women presenting for PAC and Health Professional Survey (n=115) provided an estimate of the proportion of abortions resulting in facility-based treatment of complications. Bivariate (χ2, t-test) and multivariable (binary logistic regression, Cox proportional hazard) analyses were used to compare abortion care experiences. SETTING Health facilities proving PAC in Kinshasa. PARTICIPANTS Women who presented to PAC facilities with abortion complications and their care providers. PRIMARY AND SECONDARY OUTCOME MEASURES The primary measures were abortion incidence and proportion of pregnancies unintended. The secondary measures were the odd of reporting specific abortion care experiences. RESULTS Adolescents had an estimated 27 590 induced abortions, constituting 18.8% of abortions in Kinshasa in 2016. Adolescents had the lowest abortion rate among women less than 35 years (55.2/1000 women) but the highest rate among ever sexually active women (138.4/1000) and recently sexually active women (167.2/1000). Also, adolescents had the highest abortion ratio (82.4/100 live births), proportion of pregnancies unintended (80%) and proportion of unintended pregnancies ending in abortion (49%). Compared with older women, adolescents had higher odds of reporting pregnancy unintendedness (adjusted OR, AOR 1.36, 95% CI 1.75 to 2.24), seeking abortion at later than first trimester (AOR 1.34, 95% CI 1.09 to 1.63) and from non-medical professionals (AOR 1.68, 95% CI 1.31 to 2.14), and not using contraceptives before pregnancy (AOR 2.23, 95% CI 2.77 to 3.43) or postabortion (AOR 2.46, 95% CI 1.87 to 3.29). CONCLUSIONS Interventions are needed to reduce unintended pregnancy among adolescents in Kinshasa and improve their abortion care experiences.
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Affiliation(s)
- Adesegun Fatusi
- Guttmacher Institute, New York, New York, USA
- School of Public Health, University of Medical Sciences, Ondo, Nigeria
| | | | - Patrick K Kayembe
- Department of Epidemiology & Biostatistics, School of Public Health, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
| | - Crispin Mabika
- Department of Population Sciences and Development, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
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Sagalova V, Le Dain AS, Bärnighausen T, Zagre NM, Vollmer S. Does early childbearing affect utilization of antenatal care services and infant birth weight: Evidence from West and Central African Region. J Glob Health 2021; 11:13003. [PMID: 34484710 PMCID: PMC8397281 DOI: 10.7189/jogh.11.13003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Adequate antenatal care (ANC) utilization is recognized as one of the important drivers of safe childbirth and positive birth outcomes. The usage of ANC services fluctuates with various personal, socio-economic, and cultural characteristics and in resource-poor settings, adolescent mothers are at a particularly high risk of insufficient ANC utilization. OBJECTIVES This paper investigates whether the usage of ANC services and institutional delivery as well as newborn birth weight differ systematically between adolescent and adult mothers in West and Central Africa. Moreover, we explore to what extent differences in birth weight are explained by ANC usage, adolescence, and select socio-economic characteristics of the mother. METHODS We pooled cross-sectional data from all Demographic and Health Surveys (DHS) and Multi Indicator Cluster Surveys (MICS) conducted in countries in West and Central Africa region between 1986 and 2017 to estimate measures of ANC usage and qualified delivery assistance (along with a combined measure of "adequate maternal healthcare" aggregating these two factors) and newborn birth weight by maternal age group. We estimated various regression models to analyze a) the association between adolescence and adequate prenatal and maternal health care controlling for select socio-economic maternal characteristics as well as the local environment and b) between adolescence, adequate maternal health care, and newborn birth weight outcomes, also controlling for maternal characteristics and the local environment. All regressions were linear probability models for binary outcomes and simple linear models for continuous outcomes. RESULTS Adequate maternal health care provision was lowest among adolescent mothers: 23.0% among adolescents vs an average of 29.2% across all other age groups. Moreover, we found maternal education and wealth to be positively and significantly associated with receiving adequate maternal health care. Adolescent mothers had the highest risk of low infantile birth weight with 14.5% (95% confidence interval (CI) = 13.6%-15.5%), which is roughly 1.5-2 times higher than in older mothers. We found that adolescence is still strongly associated with low birth weight even when adequate maternal health care and various socio-economic factors as well as the local environment are controlled for. CONCLUSIONS Our findings suggest that ANC supply in resource-poor settings should be particularly tailored to adolescent mothers' needs and that further research is necessary to explore what individual maternal characteristics beyond socio-economic and physical (eg, BMI) factors drive the prevalence of low birth weight. Moreover, the currently used measures of maternal care quality are heavily dependent on pure quantitative measures (number of ANC visits). New indicators incorporating measures of factual quality and scope ought to be developed and incorporated into large routine household surveys such as DHS and MICS.
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Affiliation(s)
- Vera Sagalova
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Anne-Sophie Le Dain
- United Nations Children’s Fund (UNICEF) West and Central Africa Regional Office, Dakar, Senegal
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Noel Marie Zagre
- UNICEF Area Representative for Gabon and São Tomé and Príncipe and to the ECCAS, Libreville, Gabon
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
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Carvajal L, Wilson E, Harris Requejo J, Newby H, de Carvalho Eriksson C, Liang M, Dennis M, Gohar F, Simen-Kapeu A, Idele P, Amouzou A. Basic maternal health care coverage among adolescents in 22 sub-Saharan African countries with high adolescent birth rate. J Glob Health 2021; 10:021401. [PMID: 33312517 PMCID: PMC7719354 DOI: 10.7189/jogh.10.021401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background In the sub-Saharan Africa region, the adolescent birth rate is the highest in the world, estimated at 100.5 births per 1000 women aged 15 to 19 years, and 2.4 times greater than the global average. This analysis examines coverage levels and gaps in basic maternal health care for adolescent mothers living in this region. Methods We used data from national Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) conducted between 2010 and 2016 in 22 of the sub-Saharan African Countdown to 2030 priority countries with adolescent birth rates above 100 in 2016. We analyzed 11 indicators of coverage of key services provided during the pre-pregnancy, pregnancy, delivery and postnatal period. We described the coverage level among adolescent girls aged 15-19 and women aged 20-49 for basic indicators in the continuum of care. We conducted a multilevel random effect logistic regression to quantify the association between the receipt of basic package of maternal care and woman’s socio-demographic and socio-economic characteristics. Results The median coverage of the basic package of maternal care among adolescents was extremely low, at 9.3%. Adolescent mothers who were in the highest household wealth quintile (odds ratio OR = 2.44, 95% confidence interval (CI) = 2.23-2.68), living in an urban area (OR = 1.25, 95% CI = 1.18-1.33) and having secondary education (OR = 1.61, 95% CI = 1.50-1.73) had greater odds of receiving the basic package of maternal health care as compared to those in the lowest wealth quintile, living in rural areas, and with no education respectively. Adolescent girls aged 15-17 and 18-19 had respectively 26% (OR = 0.74, 95% CI = 0.67-0.82) and 9% (OR = 0.91, 95% CI = 0.84-0.98) lower odds of receiving the basic package compared to women 20-49 years old. Child brides had 12% (OR = 0.88, 95% CI = 0.84-0.93) lower odds of receiving the basic package compared to women who were married after the age of 18. Conclusion Coverage of basic maternal health care for adolescent mothers is inadequate in the countries with the highest adolescent birth rates in the world. Addressing the reproductive and maternal health needs of adolescents in sub-Saharan Africa is of critical importance, especially given projections that this region will experience the highest increases in adolescent births in the coming decades.
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Affiliation(s)
- Liliana Carvajal
- Data and Analytics Section, Division of Data, Analytics, Policy and Monitoring, United Nations Children's Fund UNICEF, HQ, New York, New York, USA
| | - Emily Wilson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jennifer Harris Requejo
- Data and Analytics Section, Division of Data, Analytics, Policy and Monitoring, United Nations Children's Fund UNICEF, HQ, New York, New York, USA
| | | | | | - Mengjia Liang
- Population and Development Branch, Technical Division, United Nations Population Fund (UNFPA), New York, New York, USA
| | - Mardieh Dennis
- London School of Hygiene and Tropical Medicine LSHTM, London, UK
| | - Fatima Gohar
- Regional Office for Eastern and Southern Africa ESARO, UNICEF, Nairobi, Kenya
| | - Aline Simen-Kapeu
- Regional Office for West and Central Africa, WCARO, UNICEF, Dakar, Senegal
| | | | - Agbessi Amouzou
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Li Z, Patton G, Sabet F, Subramanian SV, Lu C. Maternal healthcare coverage for first pregnancies in adolescent girls: a systematic comparison with adult mothers in household surveys across 105 countries, 2000-2019. BMJ Glob Health 2021; 5:bmjgh-2020-002373. [PMID: 33037059 PMCID: PMC7549484 DOI: 10.1136/bmjgh-2020-002373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/21/2020] [Accepted: 06/16/2020] [Indexed: 11/05/2022] Open
Abstract
Background Effective maternal service delivery for adolescent mothers is essential in achieving the targets for maternal mortality under the Sustainable Development Goals. Yet little is known about levels of maternal service coverage in adolescents compared with adult mothers. Method We used data from 283 Demographic and Health Surveys or Multiple Cluster Indicator Surveys for 105 countries between 2000 and 2019 to estimate the levels and trends of inequality in coverage of five maternal health services between adolescent girls (aged 15–19) and adult mothers (aged 20–34), including receiving four or more antenatal care visits, delivering with skilled birth attendants and receiving a postnatal check-up within 24 hours of delivery. Results We analysed data from 0.9 million adolescent girls and 2.4 million adult mothers. Using the most recent data, we found adolescent girls had poorer coverage across all indicators, with receipt of four or more antenatal care visits 6.5 (95% CI 6.3 to 6.7) percentage points lower than adult mothers, delivery with skilled birth attendants 3.6 (95% CI 3.4 to 3.8) lower and having a postnatal check-up within 24 hours of delivery 3.2 (95% CI 2.8 to 3.6) lower. The coverage was 54.2% (95% CI 53.9 to 54.5) among adolescents for four or more antenatal care visits, 69.7% (95% CI 69.4 to 70.0) for delivery with skilled birth attendants and only 30.0% (95% CI 29.3 to 30.7) for receiving a postnatal check-up within 24 hours of delivery. Country-specific coverage of the maternal services increased over time in most countries, but age-related differences persisted and even worsened in some, particularly in the Western Pacific (eg, Vietnam, Lao, Cambodia and Philippines). Conclusion Even though their pregnancies are of higher risk, adolescent girls continue to lag behind adult mothers in maternal service coverage, suggesting a need for age-appropriate strategies to engage adolescents in maternal care.
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Affiliation(s)
- Zhihui Li
- Vanke School of Public Health, Tsinghua University, Beijing, China.,Global Health and Population Department, Harvard University TH Chan School of Public Health, Boston, Massachusetts, USA.,Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - George Patton
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Farnaz Sabet
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H Chan School of Public Health, Boston, Massachusetts, USA
| | - Chunling Lu
- Brigham & Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
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20
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Mugo NS, Mya KS, Raynes-Greenow C. Country compliance with WHO-recommended antenatal care guidelines: equity analysis of the 2015-2016 Demography and Health Survey in Myanmar. BMJ Glob Health 2021; 5:bmjgh-2019-002169. [PMID: 33298468 PMCID: PMC7733101 DOI: 10.1136/bmjgh-2019-002169] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction Early access to adequate antenatal care (ANC) from skilled providers is crucial for detecting and preventing obstetric complications of pregnancy. We aimed to assess factors associated with the utilisation of the new WHO ANC guidelines including the recommended number, on time initiation and adequate components of ANC contacts in Myanmar. Methods We examined data from 2943 mothers aged 15–49 years whose most recent birth occurred in the last 5 years prior to the 2015–2016 Myanmar Demographic and Health Survey. Factors associated with utilisation of the new WHO recommended ANC were explored using multinomial logistic regression and multivariate models. We used marginal standardisation methods to estimate the predicted probabilities of the factors significantly associated with the three measures of ANC. Results Approximately 18% of mothers met the new WHO recommended number of eight ANC contacts. About 58% of the mothers received adequate ANC components, and 47% initiated ANC within the first trimester of pregnancy. The predicted model shows that Myanmar could achieve 70% coverage of adequate components of ANC if all women were living in urban areas. Similarly, if ANC was through private health facilities, 63% would achieve adequate components of ANC. Pregnant women from urban areas (adjusted risk ratio (aRR): 4.86, 95% CI 2.44 to 9.68) were more than four times more likely to have adequate ANC components compared with women from rural areas. Pregnant women in the highest wealth quintile were three times more likely to receive eight or more ANC contacts (aRR: 3.20, 95% CI 1.61 to 6.36) relative to mothers from the lowest wealth quintile. On time initiation of the first ANC contact was fourfold for mothers aged 30–39 years relative to adolescent mothers (aRR: 4.07, 95% CI 1.53 to 10.84). Conclusion The 2016 WHO ANC target is not yet being met by the majority of women in Myanmar. Our results highlight the need to address health access inequity for women who are from lower socioeconomic groups, or are younger, and those living in rural areas.
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Affiliation(s)
- Ngatho Samuel Mugo
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kyaw Swa Mya
- Department of Biostatistics and Medical Demography, University of Public Health, Yangon, Myanmar
| | - Camille Raynes-Greenow
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Nguyen PH, Scott S, Khuong LQ, Pramanik P, Ahmed A, Rashid SF, Afsana K, Menon P. Adolescent birth and child undernutrition: an analysis of demographic and health surveys in Bangladesh, 1996-2017. Ann N Y Acad Sci 2021; 1500:69-81. [PMID: 33988256 PMCID: PMC8518722 DOI: 10.1111/nyas.14608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/12/2021] [Accepted: 04/20/2021] [Indexed: 11/29/2022]
Abstract
Adolescent birth is a major global concern owing to its adverse effects on maternal and child health. We assessed trends in adolescent birth and examined its associations with child undernutrition in Bangladesh using data from seven rounds of Demographic and Health Surveys (1996–2017, n = 12,006 primiparous women with living children <5 years old). Adolescent birth (10–19 years old) declined slowly, from 84% in 1996 to 71% in 2017. Compared with adult mothers (≥20 years old), young adolescent mothers (10–15 years old) were more likely to be underweight (+11 pp), have lower education (−24 pp), have less decision‐making power (−10 pp), live in poorer households (−0.9 SD) with poorer sanitation (−15 pp), and have poorer feeding practices (10 pp), and were less likely to access health and nutrition services (−3 to −24 pp). In multivariable regressions controlled for known determinants of child undernutrition, children born to adolescents had lower height‐for‐age Z‐scores (−0.29 SD for young and −0.10 SD for old adolescents (16–19 years old)), weight‐for‐age Z‐score (−0.18 and −0.06 SD, respectively) as well as higher stunting (5.9 pp) and underweight (6.0 pp) than those born to adults. In conclusion, birth during adolescence, a common occurrence in Bangladesh, is associated with child undernutrition. Policies and programs to address poverty and improve women's education can help delay marriage, reduce early childbearing, and improve child growth.
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Affiliation(s)
| | - Samuel Scott
- International Food Policy Research Institute, Washington, DC
| | | | | | - Akhter Ahmed
- International Food Policy Research Institute, Washington, DC
| | - Sabina Faiz Rashid
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Kaosar Afsana
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Purnima Menon
- International Food Policy Research Institute, Washington, DC
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22
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Carvajal L, Wilson E, Harris Requejo J, Newby H, de Carvalho Eriksson C, Liang M, Dennis M, Gohar F, Simen-Kapeu A, Idele P, Amouzou A. Basic maternal health care coverage among adolescents in 22 sub-Saharan African countries with high adolescent birth rate. J Glob Health 2020. [DOI: 10.7189/jogh.10.0201401] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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23
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Afrizal SH, Hidayanto AN, Handayani PW, Besral B, Martha E, Markam H, Budiharsana M, Eryando T. Evaluation of integrated antenatal care implementation in primary health care. JOURNAL OF INTEGRATED CARE 2020. [DOI: 10.1108/jica-07-2019-0031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis study was aimed to evaluate the implementation of an integrated antenatal care (ANC) scheme through a retrospective document study using a checklist for measuring the adequacy of the cohort ANC register documented by midwives in an urban area and to describe the barriers for the midwives during the ANC record process.Design/methodology/approachAn exploratory descriptive study using a sequential mixed method was utilised where a quantitative method was employed by collecting secondary data of 150 entries of the cohort ANC register and followed by in-depth interviews among midwives and community health workers.FindingsThe results show that the cohort registry indicators for integrated care such as laboratory and management were poorly recorded. Several barriers were found and categorised during the implementation of the integrated ANC, namely (1) governance and strategy, (2) process of care, (3) organisation and management support.Research limitations/implicationsThe contribution of this present research is that it provides empirical data of the integrated ANC implementation in primary health care (PHC) which has the responsibility to deliver an integrated level of care for ANC using a cohort registry for pregnancy registration monitoring which facilitates the continuity and quality of care.Practical implicationsPractical implication of the finding is that functional integration such as the clinical information system to facilitate an efficient and effective approach during the implementation of integrated ANC in primary care should be considered to support the clinical, professional, organisational, system and normative integration.Originality/valueSince only limited studies have been conducted to assess the quality of the cohort ANC registry and to investigate the barriers against integrated ANC implementation in Indonesia, the research findings are valuable information for the national and local governments to improve the ANC service in Indonesia.
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Olakunde BO, Adeyinka DA, Mavegam BO, Olakunde OA, Yahaya HB, Ajiboye OA, Ogundipe T, Ezeanolue EE. Factors associated with skilled attendants at birth among married adolescent girls in Nigeria: evidence from the Multiple Indicator Cluster Survey, 2016/2017. Int Health 2020; 11:545-550. [PMID: 30990520 DOI: 10.1093/inthealth/ihz017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/05/2019] [Accepted: 03/05/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study examines the factors associated with skilled birth attendants at delivery among married adolescent girls in Nigeria. METHODS The study was a secondary data analysis of the fifth round of the Multiple Indicator Cluster Survey conducted between September 2016 and January 2017. Married adolescent girls aged 15-19 y who had live births in the last 2 y preceding the survey were included in the analysis. We performed univariate and multivariate logistic regression analyses with a skilled birth attendant (doctor, nurse or midwife) at delivery as the outcome variable and sociodemographic, male partner- and maternal health-related factors as explanatory variables. RESULTS Of the 789 married adolescent girls, 387 (27% [95% CI=22.8-30.7]) had a skilled birth attendant at delivery. In the adjusted model, adolescent girls who were aged ≥18 y (ref: <18 y), primiparous (ref: multiparous), had antenatal care (ANC) provided by skilled healthcare providers (ref: no ANC), belonged to at least the poor and middle wealth index quintiles (ref: poorest), and resided in the south west zone (ref: north central), independently had a significantly higher likelihood of having a skilled birth attendant at delivery. CONCLUSIONS Interventions that will reduce pregnancy in younger adolescent girls, poverty, and increase ANC provided by skilled attendants, are likely to improve deliveries assisted by skilled birth attendants among married adolescent girls in Nigeria.
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Affiliation(s)
- Babayemi O Olakunde
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Plot 823, Ralph Shodeinde Street, Central Business District, Abuja, Nigeria
| | - Daniel A Adeyinka
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada.,National AIDS & STIs Control Programme, Federal Ministry of Health, Abuja, Nigeria
| | - Bertille O Mavegam
- Department of Environmental and Occupational Health, School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA
| | - Olubunmi A Olakunde
- Department of Disease Control and Immunization, Ondo State Primary Health Care Development Board, Ondo, Nigeria
| | - Hidayat B Yahaya
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Plot 823, Ralph Shodeinde Street, Central Business District, Abuja, Nigeria
| | - Oluwatosin A Ajiboye
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Plot 823, Ralph Shodeinde Street, Central Business District, Abuja, Nigeria
| | - Temitayo Ogundipe
- Department of Community and Family Medicine, Howard University Hospital, Washington DC, USA
| | - Echezona E Ezeanolue
- Department of Pediatrics and Child Health, University of Nigeria, Nsukka, Enugu, Nigeria.,HealthySunrise Foundation, Las Vegas, NV, USA
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Liang M, Simelane S, Fortuny Fillo G, Chalasani S, Weny K, Salazar Canelos P, Jenkins L, Moller AB, Chandra-Mouli V, Say L, Michielsen K, Engel DMC, Snow R. The State of Adolescent Sexual and Reproductive Health. J Adolesc Health 2019; 65:S3-S15. [PMID: 31761002 DOI: 10.1016/j.jadohealth.2019.09.015] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
In the 25 years since the 1994 International Conference on Population and Development, significant progress has been made in adolescent sexual and reproductive health and rights (ASRHR). Trend analysis of key ASRHR indicators at global, national, and subnational levels indicates that adolescent girls today are more likely to marry later, delay their first sexual experience, and delay their first childbirth, compared with 25 years ago; they are also more likely to use contraceptives. Despite overall progress, however, unequal progress in many ASRHR outcomes is evident both within and between countries, and in some locations, the state of adolescents' lives has worsened. Population growth in countries with some of the worst shortfalls in ASRHR mean that declining rates, of child marriage, for example, coexist with higher absolute numbers of girls affected, compared with 25 years ago. Emerging trends that warrant closer attention include increasing rates of ovarian and breast cancer among adolescent girls and sharp increases in the proportion of adolescents who are overweight or obese, which has long-term health implications.
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Affiliation(s)
| | | | | | | | | | | | - Lorna Jenkins
- Latin America and Caribbean Regional Office, UNFPA, Panama City, Panama
| | - Ann-Beth Moller
- Department of Reproductive Health and Research (RHR) and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Venkatraman Chandra-Mouli
- Department of Reproductive Health and Research (RHR), Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Lale Say
- Department of Reproductive Health and Research (RHR), Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Kristien Michielsen
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | | | - Rachel Snow
- Technical Division, UNFPA, New York, New York.
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26
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Engel DMC, Paul M, Chalasani S, Gonsalves L, Ross DA, Chandra-Mouli V, Cole CB, de Carvalho Eriksson C, Hayes B, Philipose A, Beadle S, Ferguson BJ. A Package of Sexual and Reproductive Health and Rights Interventions-What Does It Mean for Adolescents? J Adolesc Health 2019; 65:S41-S50. [PMID: 31761003 DOI: 10.1016/j.jadohealth.2019.09.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/24/2019] [Indexed: 12/28/2022]
Abstract
This article analyzes the relevance of the comprehensive definition of sexual and reproductive health and rights (SRHR) to adolescents and identifies adolescent-specific implications for the implementation of an essential package of SRHR interventions. The delivery of a comprehensive approach to SRHR targeting adolescents is underpinned by five principles-equity, quality, accountability, multisectorality, and meaningful engagement. All SRHR interventions included in the package are relevant to adolescents, given the diversity of adolescents' SRHR needs and considering their specific attributes, circumstances, and experiences. Ensuring that this package is available, accessible, and acceptable to adolescents requires an approach that looks at adolescents as being biologically and socially distinct from other age groups and acknowledges that they face some specific barriers when accessing SRHR services. This article provides cross-cutting strategies for the implementation of a comprehensive approach to SRHR for adolescents and specific considerations in delivering each intervention in the package of essential SRHR interventions. To further implement the International Conference on Population and Development Programme of Action, a prerequisite for achieving the Sustainable Development Goals, SRHR interventions must be adolescent responsive, delivered through multiple platforms, leveraging multisectoral collaboration, and strengthening accountability and participation.
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Affiliation(s)
| | - Mandira Paul
- Technical Division, United Nations Population Fund, New York, New York
| | - Satvika Chalasani
- Technical Division, United Nations Population Fund, New York, New York
| | - Lianne Gonsalves
- Department of Reproductive Health and Research, World Health Organization/Human Reproduction Programme, Geneva, Switzerland
| | - David Anthony Ross
- Department of Maternal, Newborn, Child, and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Venkatraman Chandra-Mouli
- Department of Reproductive Health and Research, World Health Organization/Human Reproduction Programme, Geneva, Switzerland
| | | | | | - Brendan Hayes
- Global Financing Facility, World Bank, Washington, DC
| | - Anandita Philipose
- Eastern and Southern Regional Office, United Nations Population Fund, Johannesburg, South Africa
| | - Sally Beadle
- Section of Health and Education, United Nations Educational, Scientific and Cultural Organization, Paris, France
| | - B Jane Ferguson
- Independent Consultant, Adolescent Health and Development, Tannay, Switzerland
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27
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Chirwa GC, Mazalale J, Likupe G, Nkhoma D, Chiwaula L, Chintsanya J. An evolution of socioeconomic related inequality in teenage pregnancy and childbearing in Malawi. PLoS One 2019; 14:e0225374. [PMID: 31747437 PMCID: PMC6867649 DOI: 10.1371/journal.pone.0225374] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 11/04/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Teenage pregnancies and childbearing are important health concerns in low-and middle-income countries (LMICs) including Malawi. Addressing these challenges requires, among other things, an understanding of the socioeconomic determinants of and contributors to the inequalities relating to these outcomes. This study investigated the trends of the inequalities and decomposed the underlying key socioeconomic factors which accounted for the inequalities in teenage pregnancy and childbearing in Malawi. METHODS The study used the 2004, 2010 and 2015-16 series of nationally representative Malawi Demographic Health Survey covering 12,719 women. We used concentration curves to examine the existence of inequalities, and then quantified the extent of inequalities in teenage pregnancies and childbearing using the Erreygers concentration index. Finally, we decomposed concentration index to find out the contribution of the determinants to socioeconomic inequality in teenage pregnancy and childbearing. RESULTS The teenage pregnancy and childbearing rate averaged 29% (p<0.01) between 2004 and 2015-16. Trends showed a "u-shape" in teenage pregnancy and childbearing rates, albeit a small one (34.1%; p<0.01) in 2004: (25.6%; p<0.01) in 2010, and (29%; p<0.01) in 2016. The calculated concentration indices -0.207 (p<0.01) in 2004, -0.133 (p<0.01) in 2010, and -0.217 (p<0.01) in 2015-16 indicated that inequality in teenage pregnancy and childbearing worsened to the disadvantage of the poor in the country. Additionally, the decomposition exercise suggested that the primary drivers to inequality in teenage pregnancy and child bearing were, early sexual debut (15.5%), being married (50%), and wealth status (13.8%). CONCLUSION The findings suggest that there is a need for sustained investment in the education of young women concerning the disadvantages of early sexual debut and early marriages, and in addressing the wealth inequalities in order to reduce the incidences of teenage pregnancies and childbearing.
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Affiliation(s)
| | - Jacob Mazalale
- Department of Economics, University of Malawi, Chancellor College, Zomba, Malawi
| | - Gloria Likupe
- Health Nursing and Midwifery, University of Hull, Hull, United Kingdom
| | - Dominic Nkhoma
- Health Policy Unit, University of Malawi, College of Medicine, Lilongwe, Malawi
| | - Levison Chiwaula
- Department of Economics, University of Malawi, Chancellor College, Zomba, Malawi
| | - Jesman Chintsanya
- Department of Population Studies, University of Malawi, Chancellor College, Zomba, Malawi
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Sully EA, Biddlecom AS, Darroch JE. Not all inequalities are equal: differences in coverage across the continuum of reproductive health services. BMJ Glob Health 2019; 4:e001695. [PMID: 31544002 PMCID: PMC6730583 DOI: 10.1136/bmjgh-2019-001695] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/30/2019] [Accepted: 07/30/2019] [Indexed: 11/20/2022] Open
Abstract
Reducing inequalities in health service coverage is central to achieving the larger goal of universal health coverage. Reproductive health services are part of evidence-based health interventions that comprise a minimum set of essential health interventions that all countries should be able to provide. This paper shows patterns in inequalities in three essential reproductive health services that span a continuum of care—contraceptive use, antenatal care during pregnancy and delivery at a health facility. We highlight coverage gaps and their impacts across geographical regions, key population subgroups and measures of inequality. We focus on reproductive age women (15–49 years) in 10 geographical regions in Africa, Asia and Latin America and the Caribbean. We examine inequalities by age (15–19, 20–24, 25–34 and 35–49 years), household wealth quintile, residence (rural or urban) and parity. Data on service coverage and the population in need are from 84 nationally representative surveys. Our results show that dominant inequalities in contraceptive coverage are varied, and include large disparities and impact by age group, compared with maternal health services, where inequalities are largest by economic status and urban–rural residence. Using multiple measures of inequality (relative, absolute and population impact) not only helps to show if there are consistent patterns in inequalities but also whether few or many different approaches are needed to reduce these inequalities and where resources could be prioritised to reach the largest number of people in need.
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29
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Doctor HV, Radovich E, Benova L. Time trends in facility-based and private-sector childbirth care: analysis of Demographic and Health Surveys from 25 sub-Saharan African countries from 2000 to 2016. J Glob Health 2019; 9:020406. [PMID: 31360446 PMCID: PMC6644920 DOI: 10.7189/jogh.09.020406] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Africa, and sub-Saharan Africa in particular, remains one of the regions with modest improvements to maternal and newborn survival and morbidity. Good quality intrapartum and early postpartum care in a health facility as well as delivery under the supervision of trained personnel is associated with improved maternal and newborn health outcomes and decreased mortality. We describe and contrast recent time trends in the scale and socio-economic inequalities in facility-based and private facility-based childbirth in sub-Saharan Africa. Methods We used Demographic and Health Surveys in two time periods (2000-2007 and 2008-2016) to analyse levels and time trends in facility-based and private facility-based deliveries for all live births in the five-year survey recall period to women aged 15-49. Household wealth quintiles were used for equity analysis. Absolute numbers of births by facility sector were calculated applying UN Population Division crude birth rates to the total country population. Results The percentage of all live births occurring in health facilities varied across countries (5%-85%) in 2000-2007. In 2008-2016, this ranged from 22% to 92%. The lowest percentage of all births occurring in private facilities in 2000-2007 period was in Ethiopia (0.3%) and the highest in the Democratic Republic of Congo at 20.5%. By 2008-2016, this ranged from 0.6% in Niger to 22.3% in Gabon. Overall, the growth in the absolute numbers of births in facilities outpaced the growth in the percentage of births in facilities. The largest increases in absolute numbers of births occurred in public sector facilities in all countries. Overall, the percentage of births occurring in facilities was significantly lower for poorest compared to wealthiest women. As the percentage of facility births increased in all countries over time, the extent of wealth-based differences had reduced between the two time periods in most countries (median risk ratio in 2008-2016 was 2.02). The majority of countries saw a narrowing in both the absolute and relative difference in facility-based deliveries between poorest and wealthiest. Conclusions The growth in facility-based deliveries, which was largely driven by the public sector, calls for increased investments in effective interventions to improve service delivery and quality of life for the mother and newborn. The goal of universal health coverage to provide better quality services can be achieved by deploying interventions that are holistic in managing and regulating the private sector to enhance performance of the health care system in its entirety rather than interventions that only target service delivery in one sector.
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Affiliation(s)
- Henry Victor Doctor
- World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Emma Radovich
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Ezran C, Bonds MH, Miller AC, Cordier LF, Haruna J, Mwanawabenea D, Randriamanambintsoa M, Razanadrakato HTR, Ouenzar MA, Razafinjato BR, Murray M, Garchitorena A. Assessing trends in the content of maternal and child care following a health system strengthening initiative in rural Madagascar: A longitudinal cohort study. PLoS Med 2019; 16:e1002869. [PMID: 31430286 PMCID: PMC6701767 DOI: 10.1371/journal.pmed.1002869] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/19/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In order to reach the health-related Sustainable Development Goals (SDGs) by 2030, gains attained in access to primary healthcare must be matched by gains in the quality of services delivered. Despite the broad consensus around the need to address quality, studies on the impact of health system strengthening (HSS) have focused predominantly on measures of healthcare access. Here, we examine changes in the content of maternal and child care as a proxy for healthcare quality, to better evaluate the effectiveness of an HSS intervention in a rural district of Madagascar. The intervention aimed at improving system readiness at all levels of care (community health, primary health centers, district hospital) through facility renovations, staffing, equipment, and training, while removing logistical and financial barriers to medical care (e.g., ambulance network and user-fee exemptions). METHODS AND FINDINGS We carried out a district-representative open longitudinal cohort study, with surveys administered to 1,522 households in the Ifanadiana district of Madagascar at the start of the HSS intervention in 2014, and again to 1,514 households in 2016. We examined changes in healthcare seeking behavior and outputs for sick-child care among children <5 years old, as well as for antenatal care and perinatal care among women aged 15-49. We used a difference-in-differences (DiD) analysis to compare trends between the intervention group (i.e., people living inside the HSS catchment area) and the non-intervention comparison group (i.e., the rest of the district). In addition, we used health facility-based surveys, monitoring service availability and readiness, to assess changes in the operational capacities of facilities supported by the intervention. The cohort study included 657 and 411 children (mean age = 2 years) reported to be ill in the 2014 and 2016 surveys, respectively (27.8% and 23.8% in the intervention group for each survey), as well as 552 and 524 women (mean age = 28 years) reported to have a live birth within the previous two years in the 2014 and 2016 surveys, respectively (31.5% and 29.6% in the intervention group for each survey). Over the two-year study period, the proportion of people who reported seeking care at health facilities experienced a relative change of +51.2% (from 41.4% in 2014 to 62.5% in 2016) and -7.1% (from 30.0% to 27.9%) in the intervention and non-intervention groups, respectively, for sick-child care (DiD p-value = 0.01); +11.4% (from 78.3% to 87.2%), and +10.3% (from 67.3% to 74.2%) for antenatal care (p-value = 0.75); and +66.2% (from 23.1% to 38.3%) and +28.9% (from 13.9% to 17.9%) for perinatal care (p-value = 0.13). Most indicators of care content, including rates of medication prescription and diagnostic test administration, appeared to increase more in the intervention compared to in the non-intervention group for the three areas of care we assessed. The reported prescription rate for oral rehydration therapy among children with diarrhea changed by +68.5% (from 29.6% to 49.9%) and -23.2% (from 17.8% to 13.7%) in the intervention and non-intervention groups, respectively (p-value = 0.05). However, trends observed in the care content varied widely by indicator and did not always match the large apparent increases observed in care seeking behavior, particularly for antenatal care, reflecting important gaps in the provision of essential health services for individuals who sought care. The main limitation of this study is that the intervention catchment was not randomly allocated, and some demographic indicators were better for this group at baseline than for the rest of the district, which could have impacted the trends observed. CONCLUSION Using a district-representative longitudinal cohort to assess the content of care delivered to the population, we found a substantial increase over the two-year study period in the prescription rate for ill children and in all World Health Organization (WHO)-recommended perinatal care outputs assessed in the intervention group, with more modest changes observed in the non-intervention group. Despite improvements associated with the HSS intervention, this study highlights the need for further quality improvement in certain areas of the district's healthcare system. We show how content of care, measured through standard population-based surveys, can be used as a component of HSS impact evaluations, enabling healthcare leaders to track progress as well as identify and address specific gaps in the provision of services that extend beyond care access.
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Affiliation(s)
- Camille Ezran
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, United States of America
- * E-mail: (CE); (AG)
| | - Matthew H. Bonds
- PIVOT, Ranomafana, Madagascar
- Department of Global Health and Social Medicine, Harvard Medical School, Blavatnik Institute, Boston, Massachusetts, United States of America
| | - Ann C. Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Blavatnik Institute, Boston, Massachusetts, United States of America
| | | | | | | | - Marius Randriamanambintsoa
- Direction de la Démographie et des Statistiques Sociales, Institut National de la Statistique, Antananarivo, Madagascar
| | - Hery-Tiana R. Razanadrakato
- Direction de la Démographie et des Statistiques Sociales, Institut National de la Statistique, Antananarivo, Madagascar
| | | | | | - Megan Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Blavatnik Institute, Boston, Massachusetts, United States of America
| | - Andres Garchitorena
- PIVOT, Ranomafana, Madagascar
- MIVEGEC, Univ Montpellier, CNRS, IRD, Montpellier, France
- * E-mail: (CE); (AG)
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Nguyen PH, Scott S, Neupane S, Tran LM, Menon P. Social, biological, and programmatic factors linking adolescent pregnancy and early childhood undernutrition: a path analysis of India's 2016 National Family and Health Survey. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:463-473. [PMID: 31105055 PMCID: PMC6558962 DOI: 10.1016/s2352-4642(19)30110-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/11/2019] [Accepted: 03/11/2019] [Indexed: 12/29/2022]
Abstract
Background Adolescent pregnancy and child undernutrition are major social and public health concerns. We aimed to examine associations between adolescent pregnancy and child undernutrition in India, where one in five adolescents live, and one in three of the world's stunted children. Methods Data were from India's fourth National Family Health Survey, 2015–16. Primiparous women aged 15–49 years who gave birth between 2010 and 2016 were classified on the basis of age at first birth: 10–19 years (adolescence), 20–24 years (young adulthood), and 25 years or older (adulthood). Primary outcomes were anthropometric measures of offspring undernutrition. Multivariable regression and structural equation models were used to understand the extent to which these measures were linked to adolescent pregnancy and the potential social, biological, and programmatic pathways. Findings Of the 60 096 women in the sample, 14 107 (25%) first gave birth during adolescence. Children born to adolescent mothers had lower Z scores for length or height-for-age (mean difference −0·53 SD), weight-for-age (–0·40 SD), and weight-for-length or height (–0·16 SD) than children born to adult mothers. Compared with adult mothers, adolescent mothers were shorter (–1·21 cm, 95% CI −1·78 to −0·65), more likely to be underweight (18 percentage points, 15–21) and anaemic (8 percentage points, 6–11), less likely to access health services (–4 to −15 percentage points), and had poorer complementary feeding practices (–3 to −9 percentage points). Adolescent mothers also had less education (–3·30 years, 95% CI −3·68 to −2·91), less bargaining power (–7 to −15 percentage points), and lived in poorer households (–0·66 SD, 96% CI −0·82 to −0·50) with poorer sanitation (–28 percentage points, −32 to −24). In the path analysis, these intermediate factors predicted child anthropometry, with the strongest links being mother's education (18%), socioeconomic status (13%), and weight (15%). Interpretation Children born to adolescent mothers are at risk of being undernourished. Adolescent pregnancy is related to child undernutrition through poor maternal nutritional status, lower education, less health service access, poor complementary feeding practices, and poor living conditions. Policies and programmes to delay pregnancy and promote women's rights could help break the intergenerational cycle of undernutrition through many routes. Funding Bill & Melinda Gates Foundation through Partnerships and Opportunities to Strengthen and Harmonize Actions for Nutrition in India, led by the International Food Policy Research Institute.
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Affiliation(s)
- Phuong Hong Nguyen
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA.
| | - Samuel Scott
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Sumanta Neupane
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | | | - Purnima Menon
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
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32
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Benova L, Neal S, Radovich EG, Ross DA, Siddiqi M, Chandra-Mouli V. Using three indicators to understand the parity-specific contribution of adolescent childbearing to all births. BMJ Glob Health 2018; 3:e001059. [PMID: 30498589 PMCID: PMC6254748 DOI: 10.1136/bmjgh-2018-001059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/24/2018] [Accepted: 09/24/2018] [Indexed: 11/03/2022] Open
Abstract
Introduction A strong focus on sexual and reproductive health of female adolescents is a key to achieving sustainable development goals, due to the large size of the current cohort in low-income and middle-income countries (LMICs) and adolescents' biological and social vulnerability. Several indicators of fertility among adolescents are in wide use, but the contribution of adolescent births to all births is poorly understood. We propose and calculate a package of three indicators capturing the contribution of adolescent births to all births, stratified by parity (first and second/higher). Methods We used Demographic and Health Survey data for 30 LMICs and vital registration for two high-income countries (to calculate levels and trends across a range of countries) for three time periods: 1990-1999, 2000-2009 and 2010-2015. The three indicators were calculated overall and by age thresholds (<16, <18 and <20 years) and exact ages, for each country and time point. Patterns of changes in indicators for the three cumulative thresholds over time are described. Results In the 30 LMICs, the percentage of all live births occurring to adolescents varied across countries, with a median of 18% for adolescents <20 years. Three countries (Jordan, Indonesia and Rwanda) had levels below 10%; Bangladesh had the highest at 33%. The contribution of adolescent first-order births to all first-order births was high; a median of 49%. Even among second-order and higher-order births, the contribution of adolescent childbearing was appreciable (median of 6%). Over the period under examination, the proportion of adolescent births among all live births declined in the majority of the LMICs. Conclusion These three indicators add to our understanding of the scale of adolescent childbearing and can be used in conjunction with population estimates to assess the absolute need for age-appropriate and parity-appropriate reproductive, maternal and newborn healthcare and to monitor progress in improving young people's health.
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Affiliation(s)
- Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Neal
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
| | - Emma G Radovich
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - David A Ross
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, London, UK
| | - Manahil Siddiqi
- Department of Reproductive Health and Research/Human Reproduction Program, World Health Organization, Geneva, Switzerland
| | - Venkatraman Chandra-Mouli
- Department of Reproductive Health and Research/Human Reproduction Program, World Health Organization, Geneva, Switzerland
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Siddique AB, Perkins J, Mazumder T, Haider MR, Banik G, Tahsina T, Islam MJ, Arifeen SE, Rahman AE. Antenatal care in rural Bangladesh: Gaps in adequate coverage and content. PLoS One 2018; 13:e0205149. [PMID: 30452444 PMCID: PMC6242304 DOI: 10.1371/journal.pone.0205149] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 09/20/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Antenatal care (ANC) has long been considered a critical component of the continuum of care during pregnancy, with the potential to contribute to the survival and thriving of women and newborns. Although ANC utilization has increased in over the past decades, adequate coverage and content of ANC contacts have fallen under increased scrutiny. The objectives of this article are to describe the coverage and content of ANC contacts in the context of rural Bangladesh. METHODS A community-based, cross-sectional household survey was conducted in two sub-districts of Netrokona district, Bangladesh in 2016. A total of 737 women with a recent birth outcome were interviewed. Respondents reported on the ANC contacts and the content of these contacts. Descriptive statistics were used to report coverage and content of ANC contacts stratified by covariates. Chi-square tests were performed to explore whether the estimates are different among different categories and significant differences were reported at p<0.05. RESULTS Around 25% of women attended at least four ANC contacts, with only 11% initiating ANC in the first trimester of pregnancy. Blood pressure was measured in almost all of the ANC contacts (92%), and abdominal examination performed in 80% and weight measured in 85% of ANC contacts. Urine tests were conducted in less than half of the ANC contacts, whereas blood screening tests and ultrasound were conducted in 45% contacts. Health care providers counselled women on danger signs in only 66% of the ANC contacts. Overall, the content of facility-based ANC contacts were better than home-based ANC contacts across all components. CONCLUSIONS Adequate coverage of ANC remains poor in Netrokona, Bangladesh and important gaps remain in the content of ANC contacts when women attend these services.
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Affiliation(s)
- Abu Bakkar Siddique
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Janet Perkins
- Health Department, Enfants du Monde, Geneva, Switzerland
| | - Tapas Mazumder
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Rifat Haider
- Department of Health Promotion, Education and Behavior, Norman J Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Goutom Banik
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Jahurul Islam
- National Newborn Health Program & Integrated Management of Childhood Illness, Directorate General of Health Services, Ministry of Health and Family Welfare (MOH&FW), Dhaka, Bangladesh
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Fracolli LA, Reticena KDO, Abreu FCPD, Chiesa AM. The implementation of a home visits program focused on parenting: an experience report. Rev Esc Enferm USP 2018; 52:e03361. [PMID: 30156655 DOI: 10.1590/s1980-220x2017044003361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/26/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To report the experience of implementing Home Visits as part of the Young Mothers Caregiver Program. METHOD The program focuses on the mother-child relationship as an object of care for developing parenting using the attachment theory, the self-efficacy theory and the bioecological theory as references. The construction of this program was centered on materials of international visitation programs, based on the translation of the material, elaboration and validation of the theoretical content. RESULTS The home visits performed by the nurses lasted an average of 1 hour, where issues related to health care, environmental health, life project, parenting, family and social network, in addition to the adolescents' demands were discussed. It was shown that nurses encountered difficulties in implementing the program. CONCLUSION By adopting Home Visits as a care tool with a focus on parenting, the experience of implementing the program proved to be an innovative technology, with great potential and relevance for promoting adolescent care and child development.
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Affiliation(s)
- Lislaine Aparecida Fracolli
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem em Saúde Coletiva, São Paulo, SP, Brasil
| | - Kesley de Oliveira Reticena
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem em Saúde Coletiva, São Paulo, SP, Brasil
| | - Flávia Corrêa Porto de Abreu
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem em Saúde Coletiva, São Paulo, SP, Brasil
| | - Anna Maria Chiesa
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem em Saúde Coletiva, São Paulo, SP, Brasil
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35
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Patton GC, Olsson CA, Skirbekk V, Saffery R, Wlodek ME, Azzopardi PS, Stonawski M, Rasmussen B, Spry E, Francis K, Bhutta ZA, Kassebaum NJ, Mokdad AH, Murray CJL, Prentice AM, Reavley N, Sheehan P, Sweeny K, Viner RM, Sawyer SM. Adolescence and the next generation. Nature 2018; 554:458-466. [PMID: 29469095 DOI: 10.1038/nature25759] [Citation(s) in RCA: 184] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/18/2018] [Indexed: 12/30/2022]
Abstract
Adolescent growth and social development shape the early development of offspring from preconception through to the post-partum period through distinct processes in males and females. At a time of great change in the forces shaping adolescence, including the timing of parenthood, investments in today's adolescents, the largest cohort in human history, will yield great dividends for future generations.
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Affiliation(s)
- George C Patton
- The University of Melbourne, Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, Parkville, Victoria 3010, Australia.,Murdoch Children's Research Institute, Parkville, Victoria 3052, Australia.,Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria 3052, Australia
| | - Craig A Olsson
- The University of Melbourne, Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, Parkville, Victoria 3010, Australia.,Murdoch Children's Research Institute, Parkville, Victoria 3052, Australia.,Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria 3052, Australia.,Deakin University Geelong, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Victoria 3220, Australia
| | - Vegard Skirbekk
- Centre for Fertility and Health, Norwegian Institute of Public Health, Nydalen, Oslo 0403, Norway.,Columbia University, New York, New York 10032, USA
| | - Richard Saffery
- The University of Melbourne, Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, Parkville, Victoria 3010, Australia.,Murdoch Children's Research Institute, Parkville, Victoria 3052, Australia
| | - Mary E Wlodek
- The University of Melbourne, Department of Physiology, Parkville, Victoria 3010, Australia
| | - Peter S Azzopardi
- The University of Melbourne, Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, Parkville, Victoria 3010, Australia.,Murdoch Children's Research Institute, Parkville, Victoria 3052, Australia.,Maternal and Child Health Program, International Development Discipline, Burnet Institute, Melbourne, Victoria 3004, Australia.,Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia 5000, Australia
| | - Marcin Stonawski
- Department of Demography, Cracow University of Economics, Cracow 31-510, Poland.,European Commission, Joint Research Centre, Centre for Advanced Studies, Ispra, Varese 21027, Italy
| | - Bruce Rasmussen
- Victoria Institute of Strategic Economic Studies, Victoria University, Melbourne, Victoria 3000, Australia
| | - Elizabeth Spry
- Murdoch Children's Research Institute, Parkville, Victoria 3052, Australia.,Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria 3052, Australia.,Deakin University Geelong, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Victoria 3220, Australia
| | - Kate Francis
- Murdoch Children's Research Institute, Parkville, Victoria 3052, Australia.,Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria 3052, Australia
| | - Zulfiqar A Bhutta
- SickKids Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario M5G 0A4, Canada.,Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - Nicholas J Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington 98121, USA.,Division of Pediatric Anesthesiology & Pain Medicine, Seattle Children's Hospital, Seattle, Washington 98105, USA
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington 98121, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington 98121, USA
| | - Andrew M Prentice
- MRC Unit The Gambia, Fajara, Gambia.,MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Nicola Reavley
- The University of Melbourne, Melbourne School of Population and Global Health, Parkville, Victoria 3010, Australia
| | - Peter Sheehan
- Victoria Institute of Strategic Economic Studies, Victoria University, Melbourne, Victoria 3000, Australia
| | - Kim Sweeny
- Victoria Institute of Strategic Economic Studies, Victoria University, Melbourne, Victoria 3000, Australia
| | - Russell M Viner
- UCL Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Susan M Sawyer
- The University of Melbourne, Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, Parkville, Victoria 3010, Australia.,Murdoch Children's Research Institute, Parkville, Victoria 3052, Australia.,Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria 3052, Australia
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36
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Myint ANM, Liabsuetrakul T, Htay TT, Wai MM, Sundby J, Bjertness E. Inequity in the utilization of antenatal and delivery care in Yangon region, Myanmar: a cross-sectional study. Int J Equity Health 2018; 17:63. [PMID: 29788972 PMCID: PMC5964903 DOI: 10.1186/s12939-018-0778-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Equity of access to and utilization of healthcare across socio-economic groups is important to achieve universal health coverage. Although the utilization of antenatal and delivery care has been increasing in low- and middle-income countries, inequities in the utilization of antenatal and delivery care have been reported in many countries, but have not yet been studied in Myanmar. This study aimed to determine whether inequities in the utilization of antenatal and delivery care existed in Yangon region, Myanmar. METHODS A community-based cross-sectional survey using multistage sampling was conducted from October to November 2016. A wealth index was selected as the main socioeconomic parameter for measuring inequities with respect to early initiation of antenatal care (ANC), number of antenatal care visits, delivery by a skilled birth attendant (SBA) and delivery by cesarean section (CS). Inequities were evaluated using concentration curves and concentration indexes. RESULTS Of the 762 women who gave birth within the 12-month survey period, there was no evidence of inequity in utilization of ANC; however, inequity of at least one antenatal visit among women aged less than 20 years was found with a concentration index of 0.04. The concentration indexes for delivery by SBA and CS were 0.05 and 0.14, respectively. Delivery by CS was disproportionately higher in adolescents and women with higher education than middle school. CONCLUSION There was no overall inequity in the utilization of ANC but substantial inequities in delivery by CS and SBA were shown. Social determinants of health, particularly age and education, were associated with inequities in the utilization of delivery care. Adolescent pregnant women were found to be particularly vulnerable, and thus should be a target group for strategic plans to reduce inequities in utilization of delivery care.
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Affiliation(s)
- Aye Nyein Moe Myint
- International Relations Division, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Tippawan Liabsuetrakul
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
| | | | - Myint Myint Wai
- Department of Medical Services (Planning), Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Johanne Sundby
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Espen Bjertness
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
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37
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Benova L, Tunçalp Ö, Moran AC, Campbell OMR. Not just a number: examining coverage and content of antenatal care in low-income and middle-income countries. BMJ Glob Health 2018; 3:e000779. [PMID: 29662698 PMCID: PMC5898334 DOI: 10.1136/bmjgh-2018-000779] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/19/2018] [Accepted: 03/20/2018] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Antenatal care (ANC) provides a critical opportunity for women and babies to benefit from good-quality maternal care. Using 10 countries as an illustrative analysis, we described ANC coverage (number of visits and timing of first visit) and operationalised indicators for content of care as available in population surveys, and examined how these two approaches are related. METHODS We used the most recent Demographic and Health Survey to analyse ANC related to women's most recent live birth up to 3 years preceding the survey. Content of care was assessed using six components routinely measured across all countries, and a further one to eight additional country-specific components. We estimated the percentage of women in need of ANC, and using ANC, who received each component, the six routine components and all components. RESULTS In all 10 countries, the majority of women in need of ANC reported 1+ ANC visits and over two-fifths reported 4+ visits. Receipt of the six routine components varied widely; blood pressure measurement was the most commonly reported component, and urine test and information on complications the least. Among the subset of women starting ANC in the first trimester and receiving 4+ visits, the percentage receiving all six routinely measured ANC components was low, ranging from 10% (Jordan) to around 50% in Nigeria, Nepal, Colombia and Haiti. CONCLUSION Our findings suggest that even among women with patterns of care that complied with global recommendations, the content of care was poor. Efficient and effective action to improve care quality relies on development of suitable content of care indicators.
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Affiliation(s)
- Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Özge Tunçalp
- Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Allisyn C Moran
- Department of Maternal, Newborn, Child and Adolescent Health, WHO, Geneva, Switzerland
| | - Oona Maeve Renee Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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38
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Adolescent mothers: too young to be neglected. THE LANCET CHILD & ADOLESCENT HEALTH 2017; 1:164-166. [PMID: 30169161 DOI: 10.1016/s2352-4642(17)30061-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 08/03/2017] [Indexed: 11/20/2022]
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