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Das S, Deepak, Singh RR. Does Empowering Women Influence Maternal Healthcare Service Utilization?: Evidence from National Family Health Survey-5, India. Matern Child Health J 2024; 28:679-690. [PMID: 37934327 DOI: 10.1007/s10995-023-03823-0] [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] [Accepted: 10/24/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Maternal healthcare service utilization is a pivotal indicator of a nation's progress in safeguarding the health and well-being of its women and children. In this context, women's empowerment emerges as a critical determinant influencing the utilization of maternal healthcare services. The study aims to assess the relationship between women's level of empowerment and utilization of maternal healthcare services among currently married women in India. DATA AND METHODS: The study uses data from the fifth round of the National Family Health Survey conducted in 2019-2021 and analyzed 26,552 (15-49 aged) currently married women who had a live birth in the last 5 years preceding the survey. Additionally, univariate and bivariate analyses, multivariate logistic regression, and the SWPER index were used for the analysis. RESULTS Over the years, utilization of antenatal care, skilled birth attainment, and postnatal care has increased extensively in India. However, the study found that utilization of services was higher among empowered women, and it varies across the state with the extent of empowerment. State-level analysis shows that the extent of women empowerment was higher in Goa, followed by Tamil Nadu and Kerala, and lower in Jharkhand, followed by Tripura, so as the utilization of maternal and health care services. The extent of empowerment and utilization of services also varies by level of educational attainment, employment, and socio-economic status. CONCLUSION There is a need for comprehensive strategies to enhance women's empowerment through education, employment, political participation, self-awareness, and reduction in gender-based violence and child marriages, which may improve awareness demand for better public health structure, and may ensure higher utilization of maternal healthcare services. Ultimately, these strategies may converse the higher maternal death and child mortality.
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Affiliation(s)
- Sunandita Das
- Department of Family and Generation, International Institute for Population Sciences, Mumbai, India
| | - Deepak
- Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Rajeev Ranjan Singh
- Department of Population and Development, International Institute for Population Sciences, Mumbai, India.
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Tajvar M, Hajizadeh A, Zalvand R. A systematic review of individual and ecological determinants of maternal mortality in the world based on the income level of countries. BMC Public Health 2022; 22:2354. [PMID: 36522731 PMCID: PMC9753301 DOI: 10.1186/s12889-022-14686-5] [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: 02/22/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND This systematic review was conducted to map the literature on all the existing evidence regarding individual and ecological determinants of maternal mortality in the world and to classify them based on the income level of countries. Such a systematic review had not been conducted before. METHODS We conducted an electronic search for primary and review articles using "Maternal Mortality" and "Determinant" as keywords or MeSH terms in their Title or Abstract, indexed in Scopus, PubMed, and Google with no time or geographical limitation and also hand searching was performed for most relevant journals. STROBE and Glasgow university critical appraisal checklists were used for quality assessment of the included studies. Data of the determinants were extracted and classified into individual or ecological categories based on income level of the countries according to World Bank classification. RESULTS In this review, 109 original studies and 12 review articles from 33 countries or at global level met the inclusion criteria. Most studies were published after 2013. Most literature studied determinants of low and lower-middle-income countries. The most important individual determinants in low and lower-middle-income countries were location of birth, maternal education, any delays in health services seeking, prenatal care and skilled birth attendance. Household-related determinants in low-income countries included improved water source and sanitation system, region of residence, house condition, wealth of household, and husband education. Additionally, ecological determinants including human resources, access to medical equipment and facilities, total fertility rate, health financing system, country income, poverty rate, governance, education, employment, social protection, gender inequality, and human development index were found to be important contributors in maternal mortality. A few factors were more important in higher-income countries than lower-income countries including parity, IVF births, older mothers, and type of delivery. CONCLUSION A comprehensive list of factors associated with maternal death was gathered through this systematic review, most of which were related to lower-income countries. It seems that the income level of the countries makes a significant difference in determinants of maternal mortality in the world.
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Affiliation(s)
- Maryam Tajvar
- grid.411705.60000 0001 0166 0922Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Hajizadeh
- grid.411705.60000 0001 0166 0922Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Rostam Zalvand
- grid.411705.60000 0001 0166 0922Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Bagade T, Chojenta C, Harris M, Oldmeadow C, Loxton D. The human right to safely give birth: data from 193 countries show that gender equality does affect maternal mortality. BMC Pregnancy Childbirth 2022; 22:874. [PMID: 36424537 PMCID: PMC9685845 DOI: 10.1186/s12884-022-05225-6] [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: 03/21/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND While a reduction in the global maternal mortality ratio (MMR) has slowed, newer strategies are needed to achieve an ongoing and sustainable reduction of the MMR. Previous studies have investigated the association between health system-related factors such as wealth inequalities, healthcare access and use on maternal mortality. However, a women's rights-based approach to address MMR has not been studied, excluding the health system-related factors. This study aimed to analyse the association between gender equality and MMR globally. METHODS Using structural equation modelling (SEM), secondary and open access data from the United Nations and other international agencies from 193 countries were analysed using structural equation modelling (SEM). Gender-sensitive variables that represented the theoretical, conceptual framework of the study were selected. The association between latent variable gender equality and the outcome, MMR, was examined in the SEM. A second SEM model (n = 158) was designed to include two variables related to gender-based violence. FINDINGS The latent variable, gender equality, was negatively associated with MMR (p < 0‧001, Z = -6‧96, 95% CI: - 6508.98 to - 3141.89 for Model 1 and p < 0‧001, Z = -7‧23, 95% CI: - 6045.356 to - 3467.515 for Model 2). INTERPRETATION Gender equality was significantly associated with maternal mortality. Investing in higher education for women, improving their paid employment opportunities, increasing participation in leadership roles and politics, reducing intimate partner violence (IPV) and ending child marriage can significantly reduce maternal mortality.
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Affiliation(s)
- Tanmay Bagade
- grid.266842.c0000 0000 8831 109XCentre for Women’s Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle (UON), University Drive, Callaghan, NSW 2308 Australia
| | - Catherine Chojenta
- grid.266842.c0000 0000 8831 109XCentre for Women’s Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle (UON), University Drive, Callaghan, NSW 2308 Australia
| | - Melissa Harris
- grid.266842.c0000 0000 8831 109XCentre for Women’s Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle (UON), University Drive, Callaghan, NSW 2308 Australia
| | - Christopher Oldmeadow
- grid.266842.c0000 0000 8831 109XCentre for Women’s Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle (UON), University Drive, Callaghan, NSW 2308 Australia ,grid.413648.cHunter Medical Research Institute, Clinical Research Design, IT and Statistical Support (CReDITSS), Level 4 West (Public Health), HMRI Building, NSW 2305 New Lambton Heights, Australia
| | - Deborah Loxton
- grid.266842.c0000 0000 8831 109XCentre for Women’s Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle (UON), University Drive, Callaghan, NSW 2308 Australia
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Sarker BK, Rahman T, Rahman T, Rahman M. Factors associated with the timely initiation of antenatal care: findings from a cross-sectional study in Northern Bangladesh. BMJ Open 2021; 11:e052886. [PMID: 34949621 PMCID: PMC8705085 DOI: 10.1136/bmjopen-2021-052886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE This paper explored the factors that influence the timely initiation of antenatal care (ANC) in Bangladesh. DESIGN This was a cross-sectional survey. SETTING This study conducted in two rural subdistricts and one urban area from three Northern districts of Bangladesh from August to November 2016. PARTICIPANTS Women who had a live birth in the last 1 year prior to data collection were enrolled for this study. In each study area, around 900 women were interviewed, and finally, we completed 2731 interviews. PRIMARY OUTCOME MEASURES The primary outcome was timely first ANC from a Medically Trained Provider (MTP). RESULTS About 43% of pregnancies were detected at their earliest time. The majority of participants (82%) received at least one ANC from an MTP. Only 11% received timely first ANC from an MTP as per the WHO FANC model. The women who detected pregnancy earlier were more likely (adj.OR 1.99, 95% CI 1.31 to 3.01) to receive the timely first ANC. The urban women were more likely (adj.OR 1.78, 95% CI 1.13 to 2.80) to receive the timely first ANC from an MTP than those of the rural women. Besides, their husbands' educational status (adj.OR 1.61, 95% CI 1.0 to 2.60) was significantly associated with the timely first ANC. CONCLUSION Apart from sociodemographic factors, early pregnancy detection was strongly associated with the timely first ANC visit. Timely initiation of ANC is an opportunity to adhere to all the WHO recommended timely ANC visits for a pregnant woman. The findings suggest maternal, neonatal, and child health programmes to focus on the early detection of pregnancy to ensure universal ANC coverage and its timeliness.
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Affiliation(s)
- Bidhan Krishna Sarker
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tawhidur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tanjina Rahman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Musfikur Rahman
- Alive & Thrive Bangladesh Program, FHI 360, Dhaka, Bangladesh
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Bala R, Singh A, Singh V, Verma P, Budhwar S, Shukla OP, Singh GP, Singh K. Impact of socio-demographic variables on antenatal services in eastern Uttar Pradesh, India. Health Care Women Int 2020; 42:580-597. [PMID: 32701388 DOI: 10.1080/07399332.2020.1789643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We investigated the impact of socio-demographic variables on antenatal care (ANC) utilization and the low birth weight of a child. Data were collected from 300 pregnant females. Only 22.5% of females received full antenatal care (≥4 visits). Our results showed that female's age at marriage and education plays a significant role in improving ANC. We observed an overall decrease in the utilization of services provided during each antenatal visit. ANC visits from the first trimester decrease the risk of having a baby with low birth weight. Awareness programs and educating families about pregnancy care are recommended to improve ANC utilization.
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Affiliation(s)
- Renu Bala
- Department of Molecular & Human Genetics, Banaras Hindu University, Varanasi, India
| | - Ajay Singh
- Institute of Environmental and Sustainable Development, Banaras Hindu University, Varanasi, India
| | - Vertika Singh
- Department of Molecular & Human Genetics, Banaras Hindu University, Varanasi, India
| | - Priyanka Verma
- Department of Molecular & Human Genetics, Banaras Hindu University, Varanasi, India
| | - Snehil Budhwar
- Department of Molecular & Human Genetics, Banaras Hindu University, Varanasi, India
| | - Om Prakash Shukla
- Department of Obstetrics & Gynaecology, Community Health Centre, Varanasi, India
| | | | - Kiran Singh
- Department of Molecular & Human Genetics, Banaras Hindu University, Varanasi, India
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Cameron L, Contreras Suarez D, Cornwell K. Understanding the determinants of maternal mortality: An observational study using the Indonesian Population Census. PLoS One 2019; 14:e0217386. [PMID: 31158243 PMCID: PMC6546237 DOI: 10.1371/journal.pone.0217386] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 05/11/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND For countries to contribute to Sustainable Development Goal 3.1 of reducing the global maternal mortality ratio (MMR) to less than 70 per 100,000 live births by 2030, identifying the drivers of maternal mortality is critically important. The ability of countries to identify the key drivers is however hampered by the lack of data sources with sufficient observations of maternal death to allow a rigorous analysis of its determinants. This paper overcomes this problem by utilising census data. In the context of Indonesia, we merge individual-level data on pregnancy-related deaths and households' socio-economic status from the 2010 Indonesian population census with detailed data on the availability and quality of local health services from the Village Census. We use these data to test the hypothesis that health service access and quality are important determinants of maternal death and explain the differences between high maternal mortality and low maternal mortality provinces. METHODS The 2010 Indonesian Population Census identifies 8075 pregnancy-related deaths and 5,866,791 live births. Multilevel logistic regression is used to analyse the impacts of demographic characteristics and the existence of, distance to and quality of health services on the likelihood of maternal death. Decomposition analysis quantifies the extent to which the difference in maternal mortality ratios between high and low performing provinces can be explained by demographic and health service characteristics. FINDINGS Health service access and characteristics account for 23% (CI: 17.2% to 28.5%) of the difference in maternal mortality ratios between high and low-performing provinces. The most important contributors are the number of doctors working at the community health centre (8.6%), the number of doctors in the village (6.9%) and distance to the nearest hospital (5.9%). Distance to health clinics and the number of midwives at community health centres and village health posts are not significant contributors, nor is socio-economic status. If the same level of access to doctors and hospitals in lower maternal mortality Java-Bali was provided to the higher maternal mortality Outer Islands of Indonesia, our model predicts 44 deaths would be averted per 100,000 pregnancies. CONCLUSION Indonesia has employed a strategy over the past several decades of increasing the supply of midwives as a way of decreasing maternal mortality. While there is evidence of reductions in maternal mortality continuing to accrue from the provision of midwife services at village health posts, our findings suggest that further reductions in maternal mortality in Indonesia may require a change of focus to increasing the supply of doctors and access to hospitals. If data on maternal death is collected in a subsequent census, future research using two waves of census data would prove a useful validation of the results found here. Similar research using census data from other countries is also likely to be fruitful.
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Affiliation(s)
- Lisa Cameron
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, Victoria, Australia
- * E-mail:
| | - Diana Contreras Suarez
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Katy Cornwell
- Centre for Development Economics and Sustainability, Monash University, Clayton, Victoria, Australia
- World Vision Australia, Burwood East, Victoria, Australia
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Urbaeva J, Lee E. A Woman'S Status and Prenatal Care Utilization in Patrilocal Households of Post-Soviet Countries. Health Care Women Int 2018; 40:158-173. [PMID: 30280986 DOI: 10.1080/07399332.2018.1510935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Women's household autonomy is associated with maternal healthcare utilization in developing countries, but its effects are not consistently positive. In the current study, the researchers test prenatal care utilization in Armenia and Azerbaijan (N = 2,159). After controlling for socioeconomic factors, we find that women's autonomy seems to be a mixed blessing. For instance, participating in daily purchases delays the start of prenatal care, but results in more prenatal care visits. Additionally, a woman's household position as a daughter-in-law has significant negative associations with accessing prenatal care during the first trimester of pregnancy.
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Affiliation(s)
- Jildyz Urbaeva
- a School of Social Welfare , SUNY University at Albany , Albany , New York , USA
| | - Eunju Lee
- a School of Social Welfare , SUNY University at Albany , Albany , New York , USA
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Yakubu Y, Mohamed Nor N, Abidin EZ. A systematic review of micro correlates of maternal mortality. REVIEWS ON ENVIRONMENTAL HEALTH 2018; 33:147-161. [PMID: 29729149 DOI: 10.1515/reveh-2017-0050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 04/12/2018] [Indexed: 06/08/2023]
Abstract
In the year 2000, the World Health Organization launched the Millennium Development Goals (MDGs) which were to be achieved in 2015. Though most of the goals were not achieved, a follow-up post 2015 development agenda, the Sustainable Development Goals (SDGs) was launched in 2015, which are to be achieved by 2030. Maternal mortality reduction is a focal goal in both the MDGs and SDGs. Achieving the maternal mortality target in the SDGs requires multiple approaches, particularly in developing countries with high maternal mortality. Low-income developing countries rely to a great extent on macro determinants such as public health expenditure, which are spent mostly on curative health and health facilities, to improve population health. To complement the macro determinants, this study employs the systematic review technique to reveal significant micro correlates of maternal mortality. The study searched MEDLINE, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Science Direct, and Global Index Medicus of the World Health Organization. Our search was time framed from the 1st January, 2000 to the 30th September, 2016. In the overall search result, 6758 articles were identified, out of which 33 were found to be eligible for the review. The outcome of the systematic search for relevant literature revealed a concentration of literature on the micro factors and maternal mortality in developing countries. This shows that maternal mortality and micro factors are a major issue in developing countries. The studies reviewed support the significant relationship between the micro factors and maternal mortality. This study therefore suggests that more effort should be channelled to improving the micro factors in developing countries to pave the way for the timely achievement of the SDGs' maternal mortality ratio (MMR) target.
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Affiliation(s)
- Yahaya Yakubu
- Department of Economics, Faculty of Economics and Management, University Putra Malaysia, Selangor, Malaysia
- Department of Economics, Faculty of Social and Management Sciences, Bauchi State University Gadau, Bauchi State, Nigeria
| | - Norashidah Mohamed Nor
- Department of Economics, Faculty of Economics and Management, University Putra Malaysia, Selangor, Malaysia
| | - Emilia Zainal Abidin
- Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Selangor, Malaysia
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9
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Feng C, Lai Y, Li R, Wang Y, Gu J, Hao C, Xu D(R, Hao Y. Reproductive health in Southeast Asian women: current situation and the influence factors. GLOBAL HEALTH JOURNAL 2018. [DOI: 10.1016/s2414-6447(19)30116-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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10
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Fan X, Zhou Z, Dang S, Xu Y, Gao J, Zhou Z, Su M, Wang D, Chen G. Exploring status and determinants of prenatal and postnatal visits in western China: in the background of the new health system reform. BMC Public Health 2017; 18:39. [PMID: 28728550 PMCID: PMC5520235 DOI: 10.1186/s12889-017-4601-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 07/14/2017] [Indexed: 11/17/2022] Open
Abstract
Background Prenatal and postnatal visits are two effective interventions for protection and promotion of maternal health by reducing maternal mortality and improving the quality of birth. There is limited nationally representative data regarding the changes of prenatal and postnatal visits since the latest health system reform initiated in 2009 in Shaanxi, China. The aim of this study was to explore the current status and determinants of prenatal and postnatal visits in the background of new health system reform. Methods Data were drawn from two waves of National Health Service Surveys in Shaanxi Province which were conducted prior and post the health system reform in 2008 and 2013, respectively. A concentration index was employed to measure the degree of income-related inequality of maternal health services utilization. Multilevel mix-effects logistic regressions were applied to study the factors associated with prenatal and postnatal visits. Results The study sample consists of 2398 women aged 15-49 years old. The data of the 5th National Health Services Survey in 2013 showed in the criterion of the World Health Organization (WHO), the percentage of women receiving ≥4 prenatal visits was 84.79% for urban women and 82.20% for rural women, with women receiving ≥3 postnatal visits were 26.48 and 25.29% for urban and rural women respectively. In the criterion of China’s ≥ 5 prenatal visits the percentages were 72.25% for urban women and 70.33% for rural women; 61.69% of urban women and 71.50% of rural women received ≥1 postnatal visits. As for urban women, the concentration index of postnatal visit utilization was −0.075 (95% CI:-0.148, −0.020) after the health system reform. The determinants related to prenatal and postnatal visits were the change of reform, women’s education, parity and the delivery institution. Conclusions This study showed the utilization of prenatal and postnatal visits met the requirement of the WHO, higher than other areas in China and other developing countries after the new health system reform. The new health system reform increased the utilization of postnatal visits in poor urban women and improved the frequency of prenatal and postnatal visits in rural women. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4601-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiaojing Fan
- School of Public Health, Center of Medical Science, Xi'an Jiaotong University, Xi'an,Shaanxi, People's Republic of China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, 76 Yanta West Road, Xi'an, Shaanxi, People's Republic of China
| | - Shaonong Dang
- School of Public Health, Center of Medical Science, Xi'an Jiaotong University, Xi'an,Shaanxi, People's Republic of China
| | - Yongjian Xu
- School of Public Policy and Administration, Xi'an Jiaotong University, 76 Yanta West Road, Xi'an, Shaanxi, People's Republic of China
| | - Jianmin Gao
- School of Public Policy and Administration, Xi'an Jiaotong University, 76 Yanta West Road, Xi'an, Shaanxi, People's Republic of China.
| | - Zhiying Zhou
- School of Public Health, Center of Medical Science, Xi'an Jiaotong University, Xi'an,Shaanxi, People's Republic of China
| | - Min Su
- School of Public Policy and Administration, Xi'an Jiaotong University, 76 Yanta West Road, Xi'an, Shaanxi, People's Republic of China
| | - Dan Wang
- School of Public Policy and Administration, Xi'an Jiaotong University, 76 Yanta West Road, Xi'an, Shaanxi, People's Republic of China
| | - Gang Chen
- School of Medicine, Flinders University, Adelaide, Australia
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Tripathi V, Singh R. Regional differences in usage of antenatal care and safe delivery services in Indonesia: findings from a nationally representative survey. BMJ Open 2017; 7:e013408. [PMID: 28159851 PMCID: PMC5293995 DOI: 10.1136/bmjopen-2016-013408] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Indonesia has shown a nominal increase in antenatal care (ANC) coverage from 93% to 96% in the Indonesia Demographic Health Survey (IDHS)-2012. This is high but for a comprehensive assessment of maternal health coverage in Indonesia, safe delivery services need to be assessed in conjunction with ANC coverage. MATERIALS AND METHODS The study uses survey data from the IDHS-2012 that was conducted among women aged 15-49 years who gave birth during the past 3 years preceding the survey. Socioeconomic and demographic factors affecting ANC coverage and safe delivery services are analysed by segregating the data into 7 regions of Indonesia. RESULTS Multivariate results show that besides wealth and education differentials, regional differences significantly affect the usage of ANC and safe delivery services across the 7 regions. Univariate analyses show that Sulawesi, Maluku and Western New Guinea islands are at a disadvantage in accessing ANC and safe delivery services. CONCLUSIONS The study recommends that disaggregated regional targets be set in order to further reduce maternal mortality rates in Indonesia.
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Affiliation(s)
- Vrijesh Tripathi
- Faculty of Science and Technology, Department of Mathematics and Statistics, The University of the West Indies, St Augustine, Trinidad and Tobago
| | - Rajvir Singh
- Cardiology Research Centre, Heart Hospital, Hamad Medical Corporation (HMC), Doha, Qatar
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Simões PP, Almeida RMVR. Maternal mortality and accessibility to health services by means of transit-network estimated traveled distances. Matern Child Health J 2015; 18:1506-11. [PMID: 24162510 DOI: 10.1007/s10995-013-1391-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study analyzed the relationship between maternal mortality and variables related to the use of health services (especially residence-hospital traveled distances estimated through transit networks). Deaths were identified for Rio de Janeiro and adjacent cities, from 2000 to 2002, and were matched by age and socio-economic level to birth admissions without maternal deaths (1 case to 3 controls). The variables used were: type of hospital (general × specialized maternity services), number of hospital beds, nature of hospital ownership (public × private-associated), main admission diagnostic, residence-hospital distance, age, income, and education. Distances were estimated by a geographic information system, and were based on most probable itineraries through the urban transit networks. The probability of death was estimated by conditional logistic regression models. 226 maternal deaths were studied, and another 10 were excluded due to incompleteness of information. The ROC area for the final model was 0.89 [95% CI (0.87-0.92)]. This model retained statistical significance for the variables admission diagnostic, type of hospital and residence-hospital distance. The death odds ratio for women who traveled 5-10 km (reference category: <5 km) was 3.84 [95% CI (1.96-7.55)]. The traveled distance measured through transit networks was an important risk factor for death in the studied population.
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Affiliation(s)
- Patricia Passos Simões
- Programa de Engenharia Biomédica, COPPE, Universidade Federal do Rio de Janeiro, Caixa Postal 68510, Cidade Universitária, Rio de Janeiro, RJ, 21941-970, Brazil
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13
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Ebu NI, Gross J. Factors influencing access to antenatal services and delivery care in sub-Saharan Africa. ACTA ACUST UNITED AC 2015. [DOI: 10.12968/ajmw.2015.9.2.58] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nancy Innocentia Ebu
- Assistant Lecturer at University of Cape Coast, School of Nursing, Cape Coast, Ghana
| | - Janet Gross
- Professor of Nursing at University of Cape Coast, School of Nursing, Cape Coast, Ghana
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Torri MC. Linking Small-Scale Commercial Activities and Women's Health: The Jamu System in Urban Areas of Java, Indonesia. JOURNAL OF SMALL BUSINESS MANAGEMENT 2015. [DOI: 10.1111/jsbm.12148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Benova L, Cumming O, Campbell OMR. Systematic review and meta-analysis: association between water and sanitation environment and maternal mortality. Trop Med Int Health 2014; 19:368-87. [PMID: 24506558 DOI: 10.1111/tmi.12275] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess whether the lack of water or the lack of sanitation facilities in either the home or in health facilities is associated with an increased risk of maternal mortality and to quantify the effect sizes. METHODS Systematic review of published literature in Medline, Embase, Popline and Africa Wide EBSCO 1980. RESULTS Fourteen articles were found. Four of five ecological studies that considered sanitation found that poor sanitation was associated with higher maternal mortality. Meta-analysis of adjusted estimates in individual-level studies indicated that women in households with poor sanitation had 3.07 (95% CI 1.72-5.49) higher odds of maternal mortality. Four of six ecological studies assessing water environment found that poor water environment was associated with higher maternal mortality. The only individual-level study looking at the adjusted effect of water showed a significant association with maternal mortality (OR = 1.50, 95% CI 1.10-2.10). Two ecological and one facility-based study found an association between a combined measure of water and sanitation environment and maternal mortality. CONCLUSIONS There is evidence of association between sanitation and maternal mortality and between water and maternal mortality. Both associations are of substantial magnitude and are maintained after adjusting for confounders. However, these conclusions are based on a very small number of studies, few of which set out to examine sanitation or water as risk factors, and only some of which adjusted for potential confounders. Nevertheless, there are plausible pathways through which such associations may operate.
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Affiliation(s)
- Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, UK
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Scott S, Chowdhury ME, Pambudi ES, Qomariyah SN, Ronsmans C. Maternal mortality, birth with a health professional and distance to obstetric care in Indonesia and Bangladesh. Trop Med Int Health 2013; 18:1193-201. [PMID: 23980717 DOI: 10.1111/tmi.12175] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the relationship between distance to a health facility, consulting a health professional and maternal mortality. METHODS Retrospective cohort study in Matlab, Bangladesh (1987-2005), to collect data on all pregnancies, births and deaths. In Java, Indonesia (2004-2005), an informant-based approach identified maternal deaths and a population-based survey sampled women who survived birth. Logistic regression was used to examine the influence of distance to a health facility and uptake of a health professional on odds of dying. RESULTS Maternal mortality was 320 per 100 000 births (95% CI: 290, 353) in Indonesia and 318 per 100 000 (95% CI: 272, 369) in Bangladesh. Women who lived further from health centres in both countries were less likely to have their births attended by health professionals than those who lived closer. For women who were assisted by a health professional, the odds of dying increased with increasing distance from a health centre [odds ratio per km; Indonesia: 1.07 (95% CI: 1.02-1.11), Bangladesh: 1.47 (95% CI: 1.22-1.78)]. There was no evidence for an association between distance to a health centre and maternal death for women who were not assisted by a health professional. CONCLUSIONS Even in settings where health services are relatively close to women's homes, distance to a health facility affects maternal mortality for women giving birth with a health professional. Women may only seek professional care in an emergency and may be unable to reach timely care when living far away from a health centre.
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Affiliation(s)
- S Scott
- London School of Hygiene and Tropical Medicine, London, UK
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Agus Y, Horiuchi S. Factors influencing the use of antenatal care in rural West Sumatra, Indonesia. BMC Pregnancy Childbirth 2012; 12:9. [PMID: 22353252 PMCID: PMC3298506 DOI: 10.1186/1471-2393-12-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 02/21/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Every year, nearly half a million women and girls needlessly die as a result of complications during pregnancy, childbirth or the 6 weeks following delivery. Almost all (99%) of these deaths occur in developing countries. The study aim was to describe the factors related to low visits for antenatal care (ANC) services among pregnant women in Indonesia. METHOD A total of 145 of 200 married women of reproductive age who were pregnant or had experienced birth responded to the questionnaire about their ANC visits. We developed a questionnaire containing 35 items and four sections. Section one and two included the women's socio demographics, section three about basic knowledge of pregnancy and section four contained two subsections about preferences about midwives and preferences about Traditional Birth Attendant (TBA) and the second subsections were traditional beliefs. Data were collected using a convenience sampling strategy during July and August 2010, from 10 villages in the Tanjung Emas. Multiple regression analysis was used for preference for types of providers. RESULTS Three-quarter of respondents (77.9%) received ANC more than four times. The other 22.1% received ANC less than four times. 59.4% received ANC visits during pregnancy, which was statistically significant compared to multiparous (p = 0.001). Women who were encouraged by their family to receive ANC had statistically significant higher traditional belief scores compared to those who encouraged themselves (p = 0.003). Preference for TBAs was most strongly affected by traditional beliefs (p < 0.001). On the contrary, preference for midwives was negatively correlated with traditional beliefs (p < 0.001). CONCLUSIONS Parity was the factor influencing women's receiving less than the recommended four ANC visits during pregnancy. Women who were encouraged by their family to get ANC services had higher traditional beliefs score than women who encouraged themselves. Moreover, traditional beliefs followed by lower income families had the greater influence over preferring TBAs, with the opposite trend for preferring midwives. Increased attention needs to be given to the women; it also very important for exploring women's perceptions about health services that they received.
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Affiliation(s)
- Yenita Agus
- St. Luke's College of Nursing, Maternal Infant Nursing and Midwifery, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan
- Syarif Hidayatullah State Islamic University, Faculty of Medicine and Health Science, Jl. Kertamukti Pisangan Ciputat, Jakarta, Indonesia
| | - Shigeko Horiuchi
- St. Luke's College of Nursing, Maternal Infant Nursing and Midwifery, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan
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Gebre T, Ayele B, Zerihun M, House JI, Stoller NE, Zhou Z, Ray KJ, Gaynor BD, Porco TC, Emerson PM, Lietman TM, Keenan JD. Latrine promotion for trachoma: assessment of mortality from a cluster-randomized trial in Ethiopia. Am J Trop Med Hyg 2011; 85:518-23. [PMID: 21896815 DOI: 10.4269/ajtmh.2011.10-0720] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Trachoma control strategies, including latrine construction and antibiotic distribution, are directed at reducing ocular chlamydia, but may have additional benefits. In a cluster-randomized clinical trial, 24 subkebeles (administrative geographic units) in Ethiopia were offered a single mass azithromycin treatment, and half were randomized to receive an intensive latrine promotion. At a follow-up census 26 months after the baseline treatment, 320 persons had died. The mortality rate of children 1-5 years of age was 3.87 (95% confidence interval [CI] = 2.19-6.82) per 1,000 person-years in the latrine promotion arm, and 2.72 (95% CI = 1.37-5.42) per 1,000 person-years in the control arm. In a multi-level mixed effects logistic regression model controlling for age, there was no difference in mortality in persons randomized into the latrine or control arms (odds ratio = 1.18, 95% CI = 0.89-1.58). Latrine promotion provided no additional effect on mortality in the context of an azithromycin distribution program (clinicaltrials.gov, #NCT00322972).
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Leite RMB, Araújo TVBD, Albuquerque RMD, Andrade ARSD, Duarte Neto PJ. Fatores de risco para mortalidade materna em área urbana do Nordeste do Brasil. CAD SAUDE PUBLICA 2011; 27:1977-85. [DOI: 10.1590/s0102-311x2011001000011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 06/27/2011] [Indexed: 11/21/2022] Open
Abstract
Este estudo de caso-controle analisou fatores de risco para mortalidade materna no Recife, Pernambuco, Brasil, no período de 2001-2005. Os casos foram 75 óbitos maternos obstétricos, identificados no Sistema de Informações sobre Mortalidade, investigados e analisados pelo Comitê de Mortalidade Materna. Os controles, selecionados no Sistema de Informações sobre Nascidos Vivos, pela amostra sistemática, foram 300 mulheres residentes no Recife cuja última gravidez ocorreu no mesmo período e não resultou em óbito. O risco de morte foi mais elevado para as usuárias do SUS (OR = 4,47; IC95%: 1,87-10,29), com idade > 35 anos (OR = 3,06; IC95%: 1,59-5,92), < 4 anos de estudo (OR = 4,95; IC95%: 2,43-10,08), que tiveram parto cesáreo (OR = 3,06; IC95%: 1,77-5,29) e para aquelas que não realizaram pré-natal ou tiveram menos de 4 consultas (OR = 9,78; IC95%: 5,52-17,34). Os resultados reafirmam as desigualdades sociais na determinação de mortalidade materna no Recife. Além disso, indicam a necessidade de aprimorar a assistência à saúde da gestante durante o pré-natal, parto e puerpério.
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Kamiya Y. Women's autonomy and reproductive health care utilisation: empirical evidence from Tajikistan. Health Policy 2011; 102:304-13. [PMID: 21592608 DOI: 10.1016/j.healthpol.2011.04.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Revised: 03/30/2011] [Accepted: 04/05/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Women's autonomy is widely considered to be a key to improving maternal health in developing countries, whereas there is no consistent empirical evidence to support this claim. This paper examines whether or not and how women's autonomy within the household affects the use of reproductive health care, using a household survey data from Tajikistan. METHODS Estimation is performed by the bivariate probit model whereby woman's use of health services and the level of women's autonomy are recursively and simultaneously determined. The data is from a sample of women aged 15-49 from the Tajikistan Living Standard Measurement Survey 2007. RESULTS Women's autonomy as measured by women's decision-making on household financial matters increase the likelihood that a woman receives antenatal and delivery care, whilst it has a negative effect on the probability of attending to four or more antenatal consultations. The hypothesis that women's autonomy and reproductive health care utilisation are independently determined is rejected for most of the estimation specifications, indicating the importance of taking into account the endogenous nature of women's autonomy when assessing its effect on health care use. CONCLUSIONS The empirical results reconfirm the assertion that women's status within the household is closely linked to reproductive health care utilisation in developing countries. Policymakers therefore need not only to implement not only direct health interventions but also to focus on broader social policies which address women's empowerment.
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Affiliation(s)
- Yusuke Kamiya
- Human Development Department, Japan International Cooperation Agency, 3rd floor, Nibancho Center Building 5-25, Niban-cho, Chiyoda-ku, Tokyo 102-8012, Japan.
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Ren Z. Utilisation of antenatal care in four counties in Ningxia, China. Midwifery 2010; 27:e260-6. [PMID: 21145633 DOI: 10.1016/j.midw.2010.10.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 08/25/2010] [Accepted: 10/29/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To analyse and evaluate the antenatal care services and its quality so as to improve the antenatal care, and make it more available and cost-effective. DESIGN Retrospective survey. A multistage sampling technique was used to select townships and villages. SETTING The four rural counties of a project in Ningxia Hui Autonomous Region in northwest China, where more than one half of the population was Hui ethnicity, the average hospital delivery rate was 47% in 2005, and the maternal mortality ratio was estimated to be higher than 65 deaths per 100,000 live births in 2005. PARTICIPANTS Five hundred and fifty-four mothers of children under the age of five were interviewed at home using a structured questionnaire between August and September in 2006. No mothers refused to take part in the survey. MEASUREMENTS AND FINDINGS The percentage using antenatal care, the number of antenatal visits and the timing of the first antenatal visit during the pregnancy of the youngest child were analysed. 78.2% of the mothers had received antenatal care services, but only 12.9% had at least five antenatal visits and 35.2% had their initial visit in the first trimester. Only 9.0% whose first antenatal visit took place during the first trimester had at least five antenatal visits. Ethnicity was an important factor determining antenatal care use. Hui mothers had significantly lower odds ratios of obtaining antenatal care in the first trimester (OR = 0.32, P < 0.001) or having at least five antenatal visits (OR = 0.11, P < 0.001) than Han mothers. KEY CONCLUSIONS The quality of the antenatal care which the women received was low. It is necessary to rethink the current model of antenatal care, and to develop and standardise a new model of antenatal care.
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Affiliation(s)
- Zhenghong Ren
- Department of Child, Adolescent and Women's Health, School of Public Health, Peking University Health Science Centre, Beijing 100191, PR China.
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Simões PP, Almeida RMVR. Geographic accessibility to obstetric care and maternal mortality in a large metropolitan area of Brazil. Int J Gynaecol Obstet 2010; 112:25-9. [PMID: 21056416 DOI: 10.1016/j.ijgo.2010.07.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 07/14/2010] [Accepted: 09/21/2010] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess maternal mortality and its association with accessibility to obstetric care in the metropolitan region of Rio de Janeiro, Brazil. METHODS Maternal mortality was assessed from 2 national databases, one administrative and the other designed for epidemiologic purposes. Distances traveled from residence to hospital via the transit network were calculated using a specialized information system. Deaths were grouped by area of residence, and maternal mortality ratios (number of deaths per 100,000 live births) as well as death incidence ratios (deaths/live births in 2 regions or hospital types) were calculated for these areas. RESULTS We identified 236 deaths and estimated under-reporting at 30%. The most common causes of death were hypertension-related disorders, "other obstetric conditions," and complications from abortion; the longest traveled distance was 66.43 km (mean, 13.65 km); and maternal mortality ratios varied between 25.54% and 56.45%, the highest values being for areas with the lowest municipal human development index. The highest death incidence ratios were found at general hospitals without specialized obstetric care. CONCLUSION Maternal mortality is still a serious problem in the studied region. The wide variations among areas of different socioeconomic conditions suggest the need for a better allocation of health care resources.
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Affiliation(s)
- Patrícia P Simões
- Programa de Engenharia Biomédica-COPPE, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Ali AAA, Osman MM, Abbaker AO, Adam I. Use of antenatal care services in Kassala, eastern Sudan. BMC Pregnancy Childbirth 2010; 10:67. [PMID: 20973972 PMCID: PMC2987884 DOI: 10.1186/1471-2393-10-67] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 10/25/2010] [Indexed: 11/22/2022] Open
Abstract
Background Antenatal care is named as one of the four pillars initiatives of the Safe Motherhood Initiative. While many of routine antenatal care procedure have little effect on maternal mortality and morbidity, some of these have been ascertained as beneficial. The aim of this study was to investigate coverage of antenatal care and identify factors associated with inadequacy of antenatal care in Kassala, eastern Sudan. Methods A cross-sectional community-based study was carried out in Kassala, eastern Sudan during September-October 2009. Household surveys were conducted. Structured questionnaires were used to gather data from women who had been pregnant within the last year, or pregnant more than 14 weeks. Results Out of 900 women investigated for antenatal care coverage, 811(90%) women had at least one visit. Only 11% of the investigated women had ≥ four antenatal visits, while 10.0% had not attended at all. Out of 811 women who attended at least one visit, 483 (59.6%), 303 (37.4%) and 25 (3.1%) women attended antenatal care in the first, second and third trimester, respectively. In logistic regression analyses, while maternal age and residence were not associated with inadequacy of antenatal care (<2 visits), high parity (OR = 2.0, CI = 1.1-3.5; P = 0.01) and husband education ≤ secondary level (OR = 2.4, CI = 1.3-4.2; P = 0.002) were associated with inadequacy of antenatal care. Conclusions Antenatal care showed a low coverage in Kassala, eastern Sudan. This low coverage was associated with high parity and low husband education.
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Halim N, Bohara AK, Ruan X. Healthy mothers, healthy children: does maternal demand for antenatal care matter for child health in Nepal? Health Policy Plan 2010; 26:242-56. [DOI: 10.1093/heapol/czq040] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Yanagisawa S, Wakai S. Professional healthcare use for life-threatening obstetric conditions. J OBSTET GYNAECOL 2009; 28:713-9. [DOI: 10.1080/01443610802463033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kozhimannil KB, Valera MR, Adams AS, Ross-Degnan D. The population-level impacts of a national health insurance program and franchise midwife clinics on achievement of prenatal and delivery care standards in the Philippines. Health Policy 2009; 92:55-64. [PMID: 19327862 DOI: 10.1016/j.healthpol.2009.02.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Revised: 02/18/2009] [Accepted: 02/24/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Adequate prenatal and delivery care are vital components of successful maternal health care provision. Starting in 1998, two programs were widely expanded in the Philippines: a national health insurance program (PhilHealth); and a donor-funded franchise of midwife clinics (Well Family Midwife Clinics). This paper examines population-level impacts of these interventions on achievement of minimum standards for prenatal and delivery care. METHODS Data from two waves of the Demographic and Health Surveys, conducted before (1998) and after (2003) scale-up of the interventions, are employed in a pre/post-study design, using longitudinal multivariate logistic and linear regression models. RESULTS After controlling for demographic and socioeconomic characteristics, the PhilHealth insurance program scale-up was associated with increased odds of receiving at least four prenatal visits (OR 1.04 [95% CI 1.01-1.06]) and receiving a visit during the first trimester of pregnancy (OR 1.03 [95% CI 1.01-1.06]). Exposure to midwife clinics was not associated with significant changes in achievement of prenatal care standards. While both programs were associated with slight increases in the odds of delivery in a health facility, these increases were not statistically significant. CONCLUSIONS These results suggest that expansion of an insurance program with accreditation standards was associated with increases in achievement of minimal standards for prenatal care among women in the Philippines.
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Affiliation(s)
- Katy Backes Kozhimannil
- Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Ave, 6th Floor, Boston, MA 02215, United States.
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Abstract
There is a large amount of research into maternal health as a health issue, but maternal health as a development issue has been less explored. This Review analyses the evidence from the past 20 years on the links between maternal health and development to examine maternal health within a development framework. We note that although existing evidence suggests that these links are strong, further research is needed to definitively substantiate how and to what extent maternal health and development affect each other. Further, we find that progress and investment in maternal health have lagged far behind estimates of what is needed to achieve the Millennium Development Goals.
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Affiliation(s)
- Kirrin Gill
- International Center for Research on Women, Washington, DC 20036, USA
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Abstract
BACKGROUND One of the United Nations' Millennium Development Goals for 2015 is to reduce the maternal mortality ratio by three fourths. Ninety-nine percent of maternal deaths occur in developing countries, and the World Health Organization encourages investigations in these settings to determine the risk factors of maternal deaths. Our aim was to identify these risk factors in a hospital-based study in Mexico. METHODS The study was conducted at the Hospital of Obstetrics and Gynecology at the Mexican Institute of Social Security in Leon, Guanajuato, Mexico, from January 1, 1992, to March 31, 2004. Women were divided into groups of 110 individuals who had died during pregnancy, delivery, or postpartum, and 440 women who survived the postpartum period. We used a logistic regression analysis to find the significant risk factors for maternal deaths. Odds ratios with 95% t confidence intervals were estimated. RESULTS The maternal mortality ratio was 47.3 per 100,000 live births. The main causes of death were hemorrhage (30.9%), preeclampsia/eclampsia (28.2%), and septic shock (10.9%). Six factors were significantly associated with maternal death: age (OR = 1.09, 95% CI = 1.00-1.18), marital status (OR = 16.2, 95% CI = 1.3-196.1), number of antenatal visits (OR = 1.3, 95% CI = 1.0-1.6), preexisting medical conditions (OR = 23.3, 95% CI = 6.6-81.6), obstetric complications in previous pregnancies (OR = 28.3, 95% CI = 4.9-163.0), and mode of delivery (OR = 1.6, 95% CI = 1.0-2.4). CONCLUSIONS Socioeconomic, medical, and obstetric risk factors are associated with maternal deaths in Mexico.
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Affiliation(s)
- Gustavo Romero-Gutiérrez
- Hospital of Obstetrics and Gynecology, Division of Health Research, Mexican Institute of Social Security, Leon, Guanajuato, Mexico
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Abstract
OBJECTIVE To identify the determinants of skilled and unskilled birth attendance. METHOD Population-based survey in a rural area in Cambodia, of women aged 15-49 years who had delivered during the previous 3-month period. An analytical framework based on Andersen's behavioural model served to identify determinants according to delivery place (facility vs. non-facility), birth attendant at home births (skilled vs. unskilled), and change of birth attendant during delivery (changed vs. unchanged). We used logistic regression to analyse the data. RESULTS Of 980 women included in the analyses, 19.8% had skilled attendants present during delivery. The determinants of facility delivery were different from those for having skilled attendants assisting in home births. In case of facility deliveries, previous contact with a skilled attendant through antenatal care was a significant determinant. In case of home births, the type of birth attendant (i.e. skilled or unskilled) at the preceding delivery was a significant determinant. CONCLUSION Community-based programmes need to reach primiparas, because once a woman has delivered with the aid of an unskilled attendant, she is five to seven times less likely to seek skilled help than a primipara.
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Affiliation(s)
- Satoko Yanagisawa
- School of Health Sciences, Faculty of Medicine, Shinshu University, Nagano, Japan.
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Abstract
The objectives of this paper are to examine factors associated with use of antenatal care in rural areas of north India, to investigate access to specific critical components of care and to study differences in the pattern of services received via health facilities versus home visits. We used the 1998-1999 Indian National Family Health Survey of ever-married women in the reproductive age group and analysed data from the states of Bihar, Madhya Pradesh, Rajasthan, and Uttar Pradesh (n = 11,369). Overall, about three-fifths of rural women did not receive any antenatal check-up during their last pregnancy. Services actually received were predominantly provision of tetanus toxoid vaccination and supply of iron and folic acid tablets. Only about 13% of pregnant women had their blood pressure checked and a blood test done at least once. Women visited by health workers received fewer services compared to women who visited a health facility. Home visits were biased towards households with a better standard of living. There was significant under-utilisation of nurse/midwives in the provision of antenatal services and doctors were often the lead providers. The average number of antenatal visits reported in this study was 2.4 and most visits were in the second trimester. Higher social and economic status was associated with increased chances of receiving an antenatal check-up, and of receiving specific components including blood pressure measurement, a blood test and urine testing but not the obstetric physical examination, which was however linked to ever-use of family planning and the education of women and their husbands. Thus, pregnant women from poor and uneducated backgrounds with at least one child were the least likely to receive antenatal check-ups and services in the four large north Indian states. Basic antenatal care components are effective means to prevent a range of pregnancy complications and reduce maternal mortality. The findings indicate substantial limitations of the health services in overcoming socio-economic and cultural barriers to access.
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Affiliation(s)
- Saseendran Pallikadavath
- 'Opportunities and Choices' Programme of Reproductive Health Research and School of Nursing and Midwifery, University of Southampton, Southampton SO16 5YA, UK
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