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Asresie MB, Dagnew GW. Effect of attending pregnant women's conference on institutional delivery, Northwest Ethiopia: comparative cross-sectional study. BMC Pregnancy Childbirth 2019; 19:353. [PMID: 31606054 PMCID: PMC6790024 DOI: 10.1186/s12884-019-2537-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 09/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background Institutional delivery is the cornerstone reducing maternal mortality. Community-based behavioral change interventions are increasing institutional delivery in developing countries. Yet, there is a dearth of information on the effect of attending pregnant women’s conferences in improving institutional delivery in Ethiopian. Therefore, this study was aimed to assess the effect of attending pregnant women’s conference on institutional delivery, Northwest Ethiopia. Methods Community-based comparative cross-sectional study was conducted in 2017 among 871 women who gave birth within the last 12 months (435: pregnant women’s conference attendants and 436: pregnant women’s conference non-attendants). Participants were selected by using a multistage-simple random sampling technique and a structured interviewer-administered questionnaire was used for data collection. Both descriptive and logistic regression analyses were performed using SPSS V.23. A P-value less than or equal to 0.05 at 95% confidence interval was set to test statistical significance. Results Institutional delivery among women who attended pregnant women’s conferences was 54.3%, higher compared with 39.9% of women who didn’t attend the conference. Likewise, the level of well-preparedness for birth was higher among women who attended the conference (38.9%) compared with their counterparts (25.7%). Being knowledgeable on childbirth (AOR = 1.7, 95%CI: 1.2, 2.8) and postpartum danger signs (AOR = 14.0, 95%CI: 4.6, 40.0), and discussed with partners/families about the place of birth (AOR = 7.7, 95%CI: 3.6, 16.4) were more likely to institutional delivery among women who attended pregnant women’s conference. Whereas, among women who didn’t attend the pregnant women’s conference, being knowledgeable about pregnancy danger signs (AOR = 3.6, 95%CI: 1.6, 8.1) were more likely to institutional delivery. In addition, the nearest health facility within 1 h of walking and well-preparedness for birth and its complication were found positively associated with institutional delivery in both groups. Conclusion Institutional delivery was low in both groups compared to the national plan, but was higher among women who attended the conference. Similarly, women’s knowledge of obstetric danger signs and preparation for birth and its complication was higher among women who attended the conference. Therefore, encouraging women to attend the pregnant women’s conference and discuss with their families about the place of delivery should be strengthened.
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Affiliation(s)
- Melash Belachew Asresie
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Gizachew Worku Dagnew
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Ipia-Ordóñez NV, Ortega-Vallejo DF, Acosta-Mora PA, López-Lasso WA, Martínez-Rodríguez JE, Corrales-Zúñiga NC, Rosero-Montero CA, Cedeño-Burbano AA. Impacto de las condiciones sociodemográficas sobre el control prenatal en Latinoamérica. REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.15446/revfacmed.v67n3.69536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. El control prenatal corresponde a una estrategia encaminada a prevenir las posibles complicaciones del embarazo, el parto y el puerperio. Diversos estudios aislados se han realizado para identificar factores que pueden afectar de forma negativa el control prenatal.Objetivo. Realizar una síntesis cualitativa de la literatura respecto al impacto de las condiciones sociodemográficas sobre el control prenatal en Latinoamérica.Materiales y métodos. Se realizó una búsqueda de la literatura a junio de 2018 en las bases de datos EBSCO, Embase, ScienceDirect, LILACS, SciELO, Cochrane Library, MEDLINE-PubMed y Google Scholar, con los términos “prenatal care” AND “Health services accessibility” AND “Pregnancy, Health services accessibility” AND “Pregnancy, prenatal care” AND “Health services accessibility” y sin límite de tiempo.Resultados. Se encontraron 13 artículos con información relevante para el desarrollo de la presente revisión.Conclusiones. La literatura disponible sugiere que condiciones sociodemográficas desfavorables podrían incidir de manera negativa sobre el control prenatal. El cuidado del hogar, la atención de otros hijos, la afiliación al sistema de seguridad social, la obligación laboral y el desempleo parecen ser los principales factores que afectan la calidad del mismo.
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Agadjanian V, Yao J, Hayford SR. Place, Time and Experience: Barriers to Universalization Of Institutional Child Delivery in Rural Mozambique. INTERNATIONAL PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2018; 42:21-31. [PMID: 28770025 DOI: 10.1363/42e0116] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
CONTEXT Although institutional coverage of childbirth is increasing in the developing world, a substantial minority of births in rural Mozambique still occur outside of health facilities. Identifying the remaining barriers to safe professional delivery services can aid in achieving universal coverage. METHODS Survey data collected in 2009 from 1,373 women in Gaza, Mozambique, were used in combination with spatial, meteorological and health facility data to examine patterns in place of delivery. Geographic information system-based visualization and mapping and exploratory spatial data analysis were used to outline the spatial distribution of home deliveries. Multilevel logistic regression models were constructed to identify associations between individual, spatial and other characteristics and whether women's most recent delivery took place at home. RESULTS Spatial analysis revealed high- and low-prevalence clusters of home births. In multivariate analyses, women with a higher number of clinics within 10 kilometers of their home had a reduced likelihood of home delivery, but those living closer to urban centers had an increased likelihood. Giving birth during the rainy, high agricultural season was positively associated with home delivery, while household wealth was negatively associated with home birth. No associations were evident for measures of exposure to and experience with health institutions. CONCLUSIONS The results suggest the need for a comprehensive approach to expansion of professional delivery services. Such an approach should complement measures facilitating physical access to health institutions for residents of harder-to-reach areas with community-based interventions aimed at improving rural women's living conditions and opportunities, while also taking into account seasonal and other variables.
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Affiliation(s)
- Victor Agadjanian
- Professor, Department of Sociology, University of Kansas, Lawrence, KS, USA
| | - Jing Yao
- Lecturer, School of Social and Political Sciences, University of Glasgow, UK
| | - Sarah R Hayford
- Associate professor, Department of Sociology and Institute for Population Research, Ohio State University, Columbus, OH, USA
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Chitalu CC, Steven K. Assessing regional variations in the effect of the removal of user fees on facility-based deliveries in rural Zambia. Afr Health Sci 2017; 17:1185-1196. [PMID: 29937891 PMCID: PMC5870268 DOI: 10.4314/ahs.v17i4.28] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Maternal health remains a concern in sub-Saharan Africa, where maternal mortality averages 680 per 100,000 live births and almost 50% of the approximately 350,000 annual maternal deaths occur. Improving access to skilled birth assistance is paramount to reducing this average, and user fee reductions could help. Objective The aim of this research was to analyse the effect of user fee removal in rural areas of Zambia on the use of health facilities for childbirth. The analysis incorporates supply-side factors, including quantitative measures of service quality in the assessment. Method The analysis uses quarterly longitudinal data covering 2003 (q1)-2008 (q4) and controls for unobserved heterogeneity, spatial dependence and quantitative supply-side factors within an Interrupted Time Series design. Results User fee removal was found to initially increase aggregate facility-based deliveries. Drug availability, the presence of traditional birth attendants, social factors and cultural factors also influenced facility-based deliveries at the national level. Conclusion Although user fees matter, to a degree, service quality is a relatively more important contributor to the promotion of facility-based deliveries. Thus, in the short-term, strengthening and improving community-based interventions could lead to further increases in facility-based deliveries.
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Gunn JKL, Ehiri JE, Jacobs ET, Ernst KC, Pettygrove S, Center KE, Osuji A, Ogidi AG, Musei N, Obiefune MC, Ezeanolue CO, Ezeanolue EE. Prevalence of Caesarean sections in Enugu, southeast Nigeria: Analysis of data from the Healthy Beginning Initiative. PLoS One 2017; 12:e0174369. [PMID: 28355302 PMCID: PMC5371319 DOI: 10.1371/journal.pone.0174369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 03/07/2017] [Indexed: 11/29/2022] Open
Abstract
Background In order to meet the Sustainable Development Goal to decrease maternal mortality, increased access to obstetric interventions such as Caesarean sections (CS) is of critical importance. As a result of women’s limited access to routine and emergency obstetric services in Nigeria, the country is a major contributor to the global burden of maternal mortality. In this analysis, we aim to establish rates of CS and determine socioeconomic or medical risk factors associated with having a CS in Enugu, southeast Nigeria. Methods Data for this study originated from the Healthy Beginning Initiative study. Participant characteristics were obtained from 2300 women at baseline via a semi-structured questionnaire. Only women between the ages of 17–45 who had singleton deliveries were retained for this analysis. Post-delivery questionnaires were used to ascertain mode-of-delivery. Crude and adjusted logistic regressions with Caesarean as the main outcome are presented. Results In this sample, 7.22% women had a CS. Compared to women who lived in an urban setting, those who lived in a rural setting had a significant reduction in the odds of having a CS (aOR: 0.58; 0.38–0.89). Significantly higher odds of having a CS were seen among those with high peripheral malaria parasitemia compared to those with low parasitemia (aOR: 1.54; 1.04–2.28). Conclusion This study revealed that contrary to the increasing trend in use of CS in low-income countries, women in this region of Nigeria had limited access to this intervention. Increasing age and socioeconomic proxies for income and access to care (e.g., having a tertiary-level education, full-time employment, and urban residence) were shown to be key determinants of access to CS. Further research is needed to ascertain the obstetric conditions under which women in this region receive CS, and to further elucidate the role of socioeconomic factors in accessing CS.
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Affiliation(s)
- Jayleen K. L. Gunn
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
- * E-mail:
| | - John E. Ehiri
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - Elizabeth T. Jacobs
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
- University of Arizona Cancer Center, Tucson, Arizona, United States of America
| | - Kacey C. Ernst
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - Sydney Pettygrove
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | | | - Alice Osuji
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria
| | - Amaka G. Ogidi
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria
| | - Nnabundo Musei
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria
| | - Michael C. Obiefune
- Healthy Sunrise Foundation, Castle Ridge Avenue, Las Vegas, Nevada, United States of America
- Institute of Human Virology, University of Maryland, Baltimore, Maryland, United States of America
| | - Chinenye O. Ezeanolue
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria
| | - Echezona E. Ezeanolue
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria
- Healthy Sunrise Foundation, Castle Ridge Avenue, Las Vegas, Nevada, United States of America
- Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, Nevada, United States of America
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Abimbola JM, Makanjuola AT, Ganiyu SA, Babatunde UMM, Adekunle DK, Olatayo AA. Pattern of utilization of ante-natal and delivery services in a semi-urban community of North-Central Nigeria. Afr Health Sci 2016; 16:962-971. [PMID: 28479888 DOI: 10.4314/ahs.v16i4.12] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Nigeria accounts for only 2% of the world's population, but contributes up to 10 % of the global estimates of maternal deaths. The study assesses the utilization of antenatal and delivery services by women of reproductive age in Afon community. METHODOLOGY It was a descriptive cross-sectional study that collected both quantitative and qualitative data using semi-structured interviewer administered questionnaire and focus group discussions (FGD). Interviews were house-hold based. FGD had two homogenous groups. Data was analysed using Epi-info version 3.5.1 software package. Level of statistical significance was set at p <0.05. RESULTS There was a high level of utilization of antenatal/delivery services in the community. Barriers to utilization of ANC/delivery services include lack of money, distance from health facility, long waiting time, poor attitude of health workers and no permission from husbands. Level of education and employment status were significantly associated with utilization of ANC/delivery services. CONCLUSION Girl-child education and women empowerment are required to improve utilization of services. Ante-natal care providers need to be trained to improve quality of care in the discharge of their duties.
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Affiliation(s)
- Jimoh Maryam Abimbola
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Akande Tanimola Makanjuola
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Salaudeen Adekunle Ganiyu
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | | | - Aremu Ayodele Olatayo
- Department of Community Medicine, Bowen University Teaching Hospital, Ogbomosho, Nigeria
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Wollum A, Burstein R, Fullman N, Dwyer-Lindgren L, Gakidou E. Benchmarking health system performance across states in Nigeria: a systematic analysis of levels and trends in key maternal and child health interventions and outcomes, 2000-2013. BMC Med 2015; 13:208. [PMID: 26329607 PMCID: PMC4557921 DOI: 10.1186/s12916-015-0438-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 07/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nigeria has made notable gains in improving childhood survival but the country still accounts for a large portion of the world's overall disease burden, particularly among women and children. To date, no systematic analyses have comprehensively assessed trends for health outcomes and interventions across states in Nigeria. METHODS We extracted data from 19 surveys to generate estimates for 20 key maternal and child health (MCH) interventions and outcomes for 36 states and the Federal Capital Territory from 2000 to 2013. Source-specific estimates were generated for each indicator, after which a two-step statistical model was applied using a mixed-effects model followed by Gaussian process regression to produce state-level trends. National estimates were calculated by population-weighting state values. RESULTS Under-5 mortality decreased in all states from 2000 to 2013, but a large gap remained across them. Malaria intervention coverage stayed low despite increases between 2009 and 2013, largely driven by rising rates of insecticide-treated net ownership. Overall, vaccination coverage improved, with notable increases in the coverage of three-dose oral polio vaccine. Nevertheless, immunization coverage remained low for most vaccines, including measles. Coverage of other MCH interventions, such as antenatal care and skilled birth attendance, generally stagnated and even declined in many states, and the range between the lowest- and highest-performing states remained wide in 2013. Countrywide, a measure of overall intervention coverage increased from 33% in 2000 to 47% in 2013 with considerable variation across states, ranging from 21% in Sokoto to 66% in Ekiti. CONCLUSIONS We found that Nigeria made notable gains for a subset of MCH indicators between 2000 and 2013, but also experienced stalled progress and even declines for others. Despite progress for a subset of indicators, Nigeria's absolute levels of intervention coverage remained quite low. As Nigeria rolls out its National Health Bill and seeks to strengthen its delivery of health services, continued monitoring of local health trends will help policymakers track successes and promptly address challenges as they arise. Subnational benchmarking ought to occur regularly in Nigeria and throughout sub-Saharan Africa to inform local decision-making and bolster health system performance.
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Affiliation(s)
- Alexandra Wollum
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA.
| | - Roy Burstein
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA.
| | - Nancy Fullman
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA.
| | - Laura Dwyer-Lindgren
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA.
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA.
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Ghosh S, Siddiqui MZ, Barik A, Bhaumik S. Determinants of Skilled Delivery Assistance in a Rural Population: Findings from an HDSS Site of Rural West Bengal, India. Matern Child Health J 2015; 19:2470-9. [PMID: 26122252 DOI: 10.1007/s10995-015-1768-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study examines the determinants of utilisation of skilled birth attendants (SBAs) amongst 2886 rural women in the state of West Bengal, India, using data from a survey of 2012-2013 conducted by the Birbhum Health and Demographic Surveillance System. METHOD Multilevel logit regression models were estimated and qualitative investigations conducted to understand the determinants of utilisation of SBAs in rural West Bengal. RESULTS Among women who delivered their last child during the 3 years preceding the survey, 69.1 % of deliveries were assisted by SBAs, while 30.9 % were home deliveries without any SBA assistance. Multivariate analysis revealed that apart from socio-demographic and economic factors (such as household affluence, women's education, birth order, uptake of comprehensive ANC check-ups, advice regarding danger signs of pregnancy and household's socio-religious affiliation), supply side factors, such as availability of skilled birth attendants in the village and all-weather roads, have significant effect on seeking skilled assistance. Our findings also show that unobserved factors at village level independently influence uptake of SBA-assisted delivery. CONCLUSIONS FOR PRACTICE The present findings emphasise that both demand and supply side intervention strategies are essential prerequisites to enhance skilled birth attendance. Ample communication is observed at the individual level, but improving community level outreach and advocacy activities could generate further demand. SBAs can be better integrated by accommodating the socio-religious needs of local communities, such as providing female doctors and doctors with similar socio-religious backgrounds.
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Affiliation(s)
- Saswata Ghosh
- Institute of Development Studies Kolkata (IDSK), DD-27/D, Sector-1, Near City Centre, Salt Lake City, 700 064, Kolkata, India.
| | - Md Zakaria Siddiqui
- Crawford School of Public Policy, Australian National University, Acton, ACT, Australia.
| | - Anamitra Barik
- Society for Health and Demographic Surveillance (SHDS), Suri, Birbhum, India.
| | - Sunil Bhaumik
- Society for Health and Demographic Surveillance (SHDS), Suri, Birbhum, India.
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Adebayo AM, Asuzu MC. Utilisation of a community-based health facility in a low-income urban community in Ibadan, Nigeria. Afr J Prim Health Care Fam Med 2015; 7:735. [PMID: 26245600 PMCID: PMC4564905 DOI: 10.4102/phcfm.v7i1.735] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 02/09/2015] [Accepted: 10/08/2014] [Indexed: 11/17/2022] Open
Abstract
Background Primary healthcare is established to ensure that people have access to health services through facilities located in their community. However, utilisation of health facilities in Nigeria remains low in many communities. Aim To assess the utilisation of community-based health facility (CBHF) amongst adults in Ibadan, Nigeria Settings A low-income community in Ibadan North West Local Government Area of Oyo State. Methods A cross-sectional survey was conducted using a simple random sampling technique to select one adult per household in all 586 houses in the community. A semi-structured interviewer-administered questionnaire was used to collect information on respondents' sociodemographic characteristics, knowledge and utilisation of the CBHF. Data analysis included descriptive statistics and association testing using the Chi-square test at p = 0.05. Results The mean age of the respondents was 46.5 ± 16.0 years; 46.0% were men and 81.0% married; 26% had no formal education and 38.0% had secondary-level education and above; traders constituted 52.0% of the sample; and 85.2% were of low socioeconomic standing; 90% had patronised the CBHF. The main reasons for non-utilisation were preference for general hospitals (13.8%) and self-medication (12.1%). Respondents who had secondary education and above, were in a higher socioeconomic class, who had good knowledge of the facility and were satisfied with care, utilised the CBHF three months significantly more than their counterparts prior to the study (p < 0.05). However, only satisfaction with care was found to be a significant predictor of utilisation of the CBHF. Conclusion The utilisation of the CBHF amongst adults in the study setting is high, driven mostly by satisfaction with the care received previously. Self-medication, promoted by uncontrolled access to drugs through pharmacies and patent medicine stores, threatens this high utilisation.
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Affiliation(s)
- Ayodeji M Adebayo
- Department of Preventive Medicine and Primary Care, College of Medicine, University of Ibadan.
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Islam N, Islam MT, Yoshimura Y. Practices and determinants of delivery by skilled birth attendants in Bangladesh. Reprod Health 2014; 11:86. [PMID: 25495451 PMCID: PMC4292816 DOI: 10.1186/1742-4755-11-86] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 11/29/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction Utilization of Skilled Birth Attendants (SBAs) at birth is low (20%) in Bangladesh. Birth attendance by SBAs is considered as the “single most important factor in preventing maternal deaths”. This paper examined the practices and determinants of delivery by SBAs in rural Bangladesh. Methods The data come from the post-intervention survey of a cluster-randomized community controlled trial conducted to evaluate the impact of limited post-natal care (PNC) services on healthcare seeking behavior of women with a recent live birth in rural Bangladesh (n = 702). Multivariable logistic regression model was used to identify the potential determinants of delivery by SBAs. Results The respondents were aged between 16 and 45, with the mean age of 24.41 (± 5.03) years. Approximately one-third (30.06%) of the women had their last delivery by SBAs. Maternal occupation, parity, complications during pregnancy and antenatal checkup (ANC) by SBAs were the significant determinants of delivery by SBAs. Women who took antenatal care by SBAs were 2.62 times as likely (95% CI: 1.66, 4.14; p < 0.001) to have their delivery conducted by SBAs compared to those who did not, after adjusting for other covariates. Conclusion Our findings suggest that ANC by SBAs and complications during pregnancies are significant determinants of delivery by SBAs. Measure should be in place to promote antenatal checkup by SBAs to increase utilization of SBAs at birth in line with achieving the Millennium Development Goal-5. Future research should focus in exploring the unmet need for, and potential barriers in, the utilization of delivery by SBAs. Electronic supplementary material The online version of this article (doi:10.1186/1742-4755-11-86) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nazrul Islam
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Room# 417, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada.
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Kawakatsu Y, Sugishita T, Oruenjo K, Wakhule S, Kibosia K, Were E, Honda S. Determinants of health facility utilization for childbirth in rural western Kenya: cross-sectional study. BMC Pregnancy Childbirth 2014; 14:265. [PMID: 25106432 PMCID: PMC4137100 DOI: 10.1186/1471-2393-14-265] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 08/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Skilled attendance at delivery is recognized as one of the most important factors in preventing maternal death. However, more than 50% of births in Kenya still occur in non-institutional locations supported by family members and/or traditional birth attendants (TBAs). To improve this situation, a study of the determinants of facility delivery, including individual, family and community factors, was necessary to consider effective intervention in Kenya. METHODS This study was conducted to identify the factors which influence the place of delivery in rural western Kenya, and to recommend ways to improve women's access to skilled attendants at delivery. A community-based cross-sectional survey was carried out from August to September 2011 in all 64 sub-locations which were covered by community health workers (CHWs). An interviewer-administered questionnaire on seventeen comprehensive variables was administered to 2,560 women who had children aged 12-24 months. RESULTS The response rate was 79% (n = 2,026). Of the respondents, 48% of births occurred in a health facility and 52% in a non-institutional location. The significant determinants of facility delivery examined using multivariate analysis were: maternal education level, maternal health knowledge, ANC visits, birth interval, economic status of household, number of household members, household sanitation practices and traveling time to nearest health facility. CONCLUSIONS The results suggest that the involvement of TBAs to promote facility delivery is still one of the most important strategies. Strengthening CHWs' performance by focusing on a limited number of topics and clear management guidance might also be an effective intervention. Stressing the importance of regular attendance at ANC (at least four times) would be effective in enhancing motivation for a facility delivery. Based on our findings, those actions to improve the facility delivery rate should focus more on pregnant women who have a low education level, poor health knowledge and short pregnancy spacing. In addition, women with low economic status, a large number of family members and a long distance to travel to a health facility should also be targeted by further interventions.
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Gayawan E. Spatial analysis of choice of place of delivery in Nigeria. SEXUAL & REPRODUCTIVE HEALTHCARE 2014; 5:59-67. [PMID: 24814440 DOI: 10.1016/j.srhc.2014.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 01/15/2014] [Accepted: 01/28/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Access to quality healthcare during childbirth is a crucial factor for taming maternal and child mortality and morbidity. Increasing this access in developing countries depends on understanding the factors influencing maternal healthcare decision at a geographical location. This study analyzes spatial pattern in choice of place of delivery in Nigeria. METHOD Data analyzed came from Nigerian Demographic and Health Survey data set. The choice of place delivery was considered a multi-categorical response and a multinomial logistic regression model used to evaluate spatial variations in choosing a particular place to deliver against home delivery. RESULTS Results show a north-south divide in choosing health facilities against homes for delivery. The likelihood of institutional delivery was significantly lower for women residing in Bayelsa and the majority of the states in northern Nigeria. As women advance in age, they have more likelihood of having institutional deliveries. Other contributing factors that favor institutional deliveries include use of antenatal care services, urban dwelling, mass media and parity. CONCLUSION Usage of mass media to campaign for institutional deliveries particularly in northern Nigeria, among younger women and those of higher parity; encouraging the use of antenatal services and even distribution of health facilities making them easily accessible to rural women are important for enhancing chances of institutional deliveries. Also, state-specific policies in this regard are indispensable.
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Affiliation(s)
- Ezra Gayawan
- Department of Mathematical Sciences, Redeemer's University, Redemption City, Nigeria; Center for Regional Development and Planning (CEDEPLAR), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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Shimazaki A, Honda S, Dulnuan MM, Chunanon JB, Matsuyama A. Factors associated with facility-based delivery in Mayoyao, Ifugao Province, Philippines. ASIA PACIFIC FAMILY MEDICINE 2013; 12:5. [PMID: 24156527 PMCID: PMC4014879 DOI: 10.1186/1447-056x-12-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 10/13/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND The maternal mortality ratio (MMR) in the Philippines is higher than in most other Southeast Asian countries, and home delivery is a major factor contributing to the high MMR. This study aims to explore the determinants for choice of delivery location in Ifugao Province, where people have poor access to health services. FINDINGS A household interview survey using a structured questionnaire was conducted to identify the factors associated with delivery location among 354 women. In all, 44.4% of the respondents delivered at a health facility. Using logistic regression analysis, parity (odds ratio [OR] 3.0, 95% confidence interval [C.I.] 1.6-5.6), higher education (OR 5.9, 95% C.I. 2.7-12.9), distance to a health facility (OR 6.9, 95% C.I. 3.4-14.2), health problems identified at antenatal care (OR 2.4, 95% C.I. 1.3-4.6), and the person deciding on the delivery location (e.g., for the husband OR 3.2, 95% C.I. 1.1-9.4) were found to be statistically associated with facility-based delivery. CONCLUSION Involving the husband and other people in the decision regarding delivery location may influence a woman's choice to use facility-based delivery services. Our findings have useful implications for improving the existing Safe Motherhood program in the Philippines.
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Affiliation(s)
| | | | | | | | - Akiko Matsuyama
- Graduate School of International Health Development, Nagasaki University, 1-12-4, Sakamoto, Nagasaki 852-8523, Japan.
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Torri MC. Choosing between Traditional Medicine and Allopathy During Pregnancy: Health Practices in Prenatal and Reproductive Health Care in Ecuador. JOURNAL OF HEALTH MANAGEMENT 2013. [DOI: 10.1177/0972063413492036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Research and programmes to date have addressed the prevalence of maternal morbidity and mortality in many developing countries. Literature has explored the direct and indirect factors influencing maternal risk, and programmes have attempted to mitigate many of the persistent factors. While addressing health system factors and socioeconomic barriers is imperative, understanding women’s perceptions within the cultural context in which they live is a necessary step for improving interventions aimed at reducing maternal morbidity and mortality. This study seeks to contribute to the existing evidence regarding Ecuadorian women’s prenatal health care seeking perceptions and behaviours. The paper will explore and describe the perceptions and experiences of pregnant women attending the antenatal intercultural clinic regarding the care they receive from both midwives and obstetricians. It will also provide recommendations for improving current strategies being implemented in Ecuador in the domain of prenatal and reproductive health care, with a special focus on indigenous people and intercultural health.
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Oyibo PG, Ebeigbe PN, Nwonwu EU. Assessment of the risk status of pregnant women presenting for antenatal care in a rural health facility in Ebonyi State, South Eastern Nigeria. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 3:424-7. [PMID: 22362452 PMCID: PMC3271398 DOI: 10.4297/najms.2011.3424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background: Nigeria has one of the worst maternal and child health indices globally. Aims: The objective of this study was to assess the risk status of pregnant women presenting for antenatal care in a rural health facility in Ebonyi State, South East Nigeria. Subjects and Method: This was a cross-sectional descriptive study of pregnant women selected by systematic random sampling. The study instrument was a pre-tested semi-structured interviewer-administered questionnaire. Result: The age range of the women in the study was 16-43 years. The mean age was 25.3 ± 1.3 years. According to the scoring system used, about one-fourth of the women (26%) had a high risk pregnancy while about a tenth (9.1%) had very high risk pregnancy. The vast majority of the women with at-risk pregnancies registered for antenatal care late: 58.9 % registered for antenatal care in the second trimester and 37.0 % registered for antenatal care in the third trimester of pregnancy. Of the women with an at-risk pregnancy, 79.5% had their last delivery at home and 67.1 % of them preferred to deliver at home in their current pregnancies. Conclusion: This study revealed that a substantial proportion of rural women with at-risk pregnancies go through their pregnancy period without significant modern antenatal care. The local government health department should intensify efforts through health enlightenment campaigns to educate rural pregnant women of the benefits of utilizing modern antenatal care services.
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Affiliation(s)
- Patrick Gold Oyibo
- Department of Community Medicine, Delta State University, Abraka, Delta State, Nigeria
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Akpabio II, Edet OB, Etifit RE, Robinson-Bassey G. Preferences for traditional or modern practitioners: A comparative study. ACTA ACUST UNITED AC 2012. [DOI: 10.12968/ajmw.2012.6.1.13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Idongesit I. Akpabio
- Department of Nursing Science, College of Medical Sciences, University of Calabar, Calabar Nigeria
| | - Olaide B. Edet
- Department of Nursing Science, College of Medical Sciences, University of Calabar, Calabar Nigeria
| | - Rita E. Etifit
- Department of Nursing Science, College of Medical Sciences, University of Calabar, Calabar Nigeria and
| | - G.C. Robinson-Bassey
- Department of Nursing Science, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
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Improving maternal mortality at a university teaching hospital in Nnewi, Nigeria. Int J Gynaecol Obstet 2011; 116:197-200. [DOI: 10.1016/j.ijgo.2011.10.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 10/15/2011] [Accepted: 11/22/2011] [Indexed: 11/20/2022]
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Aremu O, Lawoko S, Dalal K. Neighborhood socioeconomic disadvantage, individual wealth status and patterns of delivery care utilization in Nigeria: a multilevel discrete choice analysis. Int J Womens Health 2011; 3:167-74. [PMID: 21792338 PMCID: PMC3140812 DOI: 10.2147/ijwh.s21783] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background High maternal mortality continues to be a major public health problem in most part of the developing world, including Nigeria. Understanding the utilization pattern of maternal healthcare services has been accepted as an important factor for reducing maternal deaths. This study investigates the effect of neighborhood and individual socioeconomic position on the utilization of different forms of place of delivery among women of reproductive age in Nigeria. Methods A population-based multilevel discrete choice analysis was performed using the most recent population-based 2008 Nigerian Demographic and Health Surveys data of women aged between 15 and 49 years. The analysis was restricted to 15,162 ever-married women from 888 communities across the 36 states of the federation including the Federal Capital Territory of Abuja. Results The choice of place to deliver varies across the socioeconomic strata. The results of the multilevel discrete choice models indicate that with every other factor controlled for, the household wealth status, women’s occupation, women’s and partner’s high level of education attainment, and possession of health insurance were associated with use of private and government health facilities for child birth relative to home delivery. The results also show that higher birth order and young maternal age were associated with use of home delivery. Living in a highly socioeconomic disadvantaged neighborhood is associated with home birth compared with the patronage of government health facilities. More specifically, the result revealed that choice of facility-based delivery is clustered around the neighborhoods. Conclusion Home delivery, which cuts across all socioeconomic strata, is a common practice among women in Nigeria. Initiatives that would encourage the appropriate use of healthcare facilities at little or no cost to the most disadvantaged should be accorded the utmost priority.
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Affiliation(s)
- Olatunde Aremu
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Delivery practices and associated factors among mothers seeking child welfare services in selected health facilities in Nyandarua South District, Kenya. BMC Public Health 2011; 11:360. [PMID: 21599994 PMCID: PMC3112141 DOI: 10.1186/1471-2458-11-360] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 05/21/2011] [Indexed: 11/25/2022] Open
Abstract
Background A measure of the proportion of deliveries assisted by skilled attendants is one of the indicators of progress towards achieving Millennium Development Goal (MDG) 5, which aims at improving maternal health. This study aimed at establishing delivery practices and associated factors among mothers seeking child welfare services at selected health facilities in Nyandarua South district, Kenya to determine whether mothers were receiving appropriate delivery care. Methods A hospital-based cross-sectional survey among women who had recently delivered while in the study area was carried out between August and October 2009. Binary Logistic regression was used to identify factors that predicted mothers' delivery practice. Results Among the 409 mothers who participated in the study, 1170 deliveries were reported. Of all the deliveries reported, 51.8% were attended by unskilled birth attendants. Among the deliveries attended by unskilled birth attendants, 38.6% (452/1170) were by neighbors and/or relatives. Traditional Birth Attendants attended 1.5% (17/1170) of the deliveries while in 11.7% (137/1170) of the deliveries were self administered. Mothers who had unskilled birth attendance were more likely to have <3 years of education (Adjusted Odds ratio [AOR] 19.2, 95% confidence interval [CI] 1.7 - 212.8) and with more than three deliveries in a life time (AOR 3.8, 95% CI 2.3 - 6.4). Mothers with perceived similarity in delivery attendance among skilled and unskilled delivery attendants were associated with unsafe delivery practice (AOR 1.9, 95% CI 1.1 - 3.4). Mother's with lower knowledge score on safe delivery (%) were more likely to have unskilled delivery attendance (AOR 36.5, 95% CI 4.3 - 309.3). Conclusion Among the mothers interviewed, utilization of skilled delivery attendance services was still low with a high number of deliveries being attended by unqualified lay persons. There is need to implement cost effective and sustainable measures to improve the quality of maternal health services with an aim of promoting safe delivery and hence reducing maternal mortality.
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Some TD, Sombie I, Meda N. Women's perceptions of homebirths in two rural medical districts in Burkina Faso: a qualitative study. Reprod Health 2011; 8:3. [PMID: 21276252 PMCID: PMC3037305 DOI: 10.1186/1742-4755-8-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 01/28/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In developing countries, most childbirth occurs at home and is not assisted by skilled attendants. The situation increases the risk of death for both mother and child and has severe maternal complications. The purpose of this study was to describe women's perceptions of homebirths in the medical districts of Ouargaye and Diapaga. METHODS A qualitative approach was used to gather information. This information was collected by using focus group discussions and individual interviews with 30 women. All the interviews were tape recorded and managed by using QSR NVIVO 2.0, qualitative data management software. RESULTS The findings show that homebirths are frequent because of prohibitive distance to health facilities, fast labour and easy labour, financial constraints, lack of decision making power to reach health facilities. CONCLUSION The study echoes the need for policy makers to make health facilities easily available to rural inhabitants to forestall maternal and child deaths in the two districts.
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Affiliation(s)
- Télesphore D Some
- Centre Muraz, Avenue Mamadou Konaté, P.O. Box 390 Bobo-Dioulasso, Burkina
| | - Issiaka Sombie
- Centre Muraz, Avenue Mamadou Konaté, P.O. Box 390 Bobo-Dioulasso, Burkina
| | - Nicolas Meda
- Centre Muraz, Avenue Mamadou Konaté, P.O. Box 390 Bobo-Dioulasso, Burkina
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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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Mushi D, Mpembeni R, Jahn A. Effectiveness of community based Safe Motherhood promoters in improving the utilization of obstetric care. The case of Mtwara Rural District in Tanzania. BMC Pregnancy Childbirth 2010; 10:14. [PMID: 20359341 PMCID: PMC2858713 DOI: 10.1186/1471-2393-10-14] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Accepted: 04/01/2010] [Indexed: 11/10/2022] Open
Abstract
Background In Tanzania, maternal mortality ratio remains unacceptably high at 578/100,000 live births. Despite a high coverage of antenatal care (96%), only 44% of deliveries take place within the formal health services. Still, "Ensure skilled attendant at birth" is acknowledged as one of the most effective interventions to reduce maternal deaths. Exploring the potential of community-based interventions in increasing the utilization of obstetric care, the study aimed at developing, testing and assessing a community-based safe motherhood intervention in Mtwara rural District of Tanzania. Method This community-based intervention was designed as a pre-post comparison study, covering 4 villages with a total population of 8300. Intervention activities were implemented by 50 trained safe motherhood promoters (SMPs). Their tasks focused on promoting early and complete antenatal care visits and delivery with a skilled attendant. Data on all 512 deliveries taking place from October 2004 to November 2006 were collected by the SMPs and cross-checked with health service records. In addition 242 respondents were interviewed with respect to knowledge on safe motherhood issues and their perception of the SMP's performance. Skilled delivery attendance was our primary outcome; secondary outcomes included antenatal care attendance and knowledge on Safe Motherhood issues. Results Deliveries with skilled attendant significantly increased from 34.1% to 51.4% (ρ < 0.05). Early ANC booking (4 to 16 weeks) rose significantly from 18.7% at baseline to 37.7% in 2005 and 56.9% (ρ < 0.001) at final assessment. After two years 44 (88%) of the SMPs were still active, 79% of pregnant women were visited. Further benefits included the enhancement of male involvement in safe motherhood issues. Conclusion The study has demonstrated the effectiveness of community-based safe motherhood intervention in promoting the utilization of obstetric care and a skilled attendant at delivery. This improvement is attributed to the SMPs' home visits and the close collaboration with existing community structures as well as health services.
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Affiliation(s)
- Declare Mushi
- Department of Community Health, Tumaini University-Kilimanjaro Christian Medical Centre, P.O. Box, 2240, Moshi, Kilimanjaro, Tanzania.
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Du Q, Nass O, Bergsjo P, Kumar BN. Determinants for high maternal mortality in multiethnic populations in western China. Health Care Women Int 2009; 30:957-70. [PMID: 19809900 DOI: 10.1080/07399330903052137] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Our purpose of this study was to investigate determinants and patterns of associations with high maternal mortality in poor and multiethnic populations from the Xinjiang Uigur autonomous region of Western China. The researcher found that the maternal mortality ratio of Xinjiang was very high; almost half of the participants delivered at home without clean delivery, and nearly one-fifth of the participants had not received any medical treatment. Eighty-seven percent of maternal deaths were among ethnic minority groups. In multiethnic areas in Xinjiang, social-culture factors, lack of health resources, and low health services utilization were related to high maternal mortality.
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Affiliation(s)
- Qing Du
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China.
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Babalola S, Fatusi A. Determinants of use of maternal health services in Nigeria--looking beyond individual and household factors. BMC Pregnancy Childbirth 2009; 9:43. [PMID: 19754941 PMCID: PMC2754433 DOI: 10.1186/1471-2393-9-43] [Citation(s) in RCA: 391] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Accepted: 09/15/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Utilization of maternal health services is associated with improved maternal and neonatal health outcomes. Considering global and national interests in the Millennium Development Goal and Nigeria's high level of maternal mortality, understanding the factors affecting maternal health use is crucial. Studies on the use of maternal care services have largely overlooked community and other contextual factors. This study examined the determinants of maternal services utilization in Nigeria, with a focus on individual, household, community and state-level factors. METHODS Data from the 2005 National HIV/AIDS and Reproductive Health Survey - an interviewer-administered nationally representative survey - were analyzed to identify individual, household and community factors that were significantly associated with utilization of maternal care services among 2148 women who had a baby during the five years preceding the survey. In view of the nested nature of the data, we used multilevel analytic methods and assessed state-level random effects. RESULTS Approximately three-fifths (60.3%) of the mothers used antenatal services at least once during their most recent pregnancy, while 43.5% had skilled attendants at delivery and 41.2% received postnatal care. There are commonalities and differences in the predictors of the three indicators of maternal health service utilization. Education is the only individual-level variable that is consistently a significant predictor of service utilization, while socio-economic level is a consistent significant predictor at the household level. At the community level, urban residence and community media saturation are consistently strong predictors. In contrast, some factors are significant in predicting one or more of the indicators of use but not for all. These inconsistent predictors include some individual level variables (the woman's age at the birth of the last child, ethnicity, the notion of ideal family size, and approval of family planning), a community-level variable (prevalence of the small family norm in the community), and a state-level variable (ratio of PHC to the population). CONCLUSION Factors influencing maternal health services utilization operate at various levels - individual, household, community and state. Depending on the indicator of maternal health services, the relevant determinants vary. Effective interventions to promote maternal health service utilization should target the underlying individual, household, community and policy-level factors. The interventions should reflect the relative roles of the various underlying factors.
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Affiliation(s)
- Stella Babalola
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, USA.
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Gabrysch S, Campbell OMR. Still too far to walk: literature review of the determinants of delivery service use. BMC Pregnancy Childbirth 2009; 9:34. [PMID: 19671156 PMCID: PMC2744662 DOI: 10.1186/1471-2393-9-34] [Citation(s) in RCA: 755] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Accepted: 08/11/2009] [Indexed: 11/11/2022] Open
Abstract
Background Skilled attendance at childbirth is crucial for decreasing maternal and neonatal mortality, yet many women in low- and middle-income countries deliver outside of health facilities, without skilled help. The main conceptual framework in this field implicitly looks at home births with complications. We expand this to include "preventive" facility delivery for uncomplicated childbirth, and review the kinds of determinants studied in the literature, their hypothesized mechanisms of action and the typical findings, as well as methodological difficulties encountered. Methods We searched PubMed and Ovid databases for reviews and ascertained relevant articles from these and other sources. Twenty determinants identified were grouped under four themes: (1) sociocultural factors, (2) perceived benefit/need of skilled attendance, (3) economic accessibility and (4) physical accessibility. Results There is ample evidence that higher maternal age, education and household wealth and lower parity increase use, as does urban residence. Facility use in the previous delivery and antenatal care use are also highly predictive of health facility use for the index delivery, though this may be due to confounding by service availability and other factors. Obstetric complications also increase use but are rarely studied. Quality of care is judged to be essential in qualitative studies but is not easily measured in surveys, or without linking facility records with women. Distance to health facilities decreases use, but is also difficult to determine. Challenges in comparing results between studies include differences in methods, context-specificity and the substantial overlap between complex variables. Conclusion Studies of the determinants of skilled attendance concentrate on sociocultural and economic accessibility variables and neglect variables of perceived benefit/need and physical accessibility. To draw valid conclusions, it is important to consider as many influential factors as possible in any analysis of delivery service use. The increasing availability of georeferenced data provides the opportunity to link health facility data with large-scale household data, enabling researchers to explore the influences of distance and service quality.
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Affiliation(s)
- Sabine Gabrysch
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
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Kiwuwa MS, Mufubenga P. Use of antenatal care, maternity services, intermittent presumptive treatment and insecticide treated bed nets by pregnant women in Luwero district, Uganda. Malar J 2008; 7:44. [PMID: 18312682 PMCID: PMC2292202 DOI: 10.1186/1475-2875-7-44] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Accepted: 03/01/2008] [Indexed: 11/13/2022] Open
Abstract
Background To reduce the intolerable burden of malaria in pregnancy, the Ministry of Health in Uganda improved the antenatal care package by including a strong commitment to increase distribution of insecticide-treated nets (ITNs) and introduction of intermittent preventive treatment with sulphadoxine-pyrimethamine for pregnant women (IPTp-SP) as a national policy in 2000. This study assessed uptake of both ITNs and IPTp-SP by pregnant women as well as antenatal and maternity care use with the aim of optimizing their delivery. Methods 769 post-partum women were recruited from a rural area of central Uganda with perennial malaria transmission through a cross-sectional, community-based household survey in May 2005. Results Of the 769 women interviewed, antenatal clinic (ANC) attendance was high (94.4%); 417 (57.7%) visiting initially during the 2nd trimester, 242 (33.5%) during the 3rd trimester and 266 (37.1%) reporting ≥ 4 ANC visits. About 537 (71%) and 272 (35.8%) received one or ≥ 2 IPTp-SP doses respectively. Only 85 (15.8%) received the first dose of IPTp-SP in the 3rd trimester. ITNs were used by 239 (31.3%) of women during pregnancy and 314 (40.8%) delivered their most recent pregnancy outside a health facility. Post-partum women who lacked post-primary education were more likely not to have attended four or more ANC visits (odds ratio [OR] 3.3, 95% confidence interval [CI] 1.2–9.3). Conclusion These findings illustrate the need to strengthen capacity of the district to further improve antenatal care and maternity services utilization and IPTp-SP uptake. More specific and effective community health strategies to improve effective ANC, maternity services utilization and IPTp-SP uptake in rural communities should be undertaken.
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Affiliation(s)
- Mpungu S Kiwuwa
- Clinical Epidemiology Unit, Faculty of Medicine, Makerere University, Uganda.
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Say L, Raine R. A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context. Bull World Health Organ 2007; 85:812-9. [PMID: 18038064 DOI: 10.2471/blt.06.035659] [Citation(s) in RCA: 336] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2006] [Accepted: 05/07/2007] [Indexed: 11/27/2022] Open
Abstract
Two decades after the Safe Motherhood campaigns 1987 launch in India, half a million women continue to die from pregnancy-related causes every year. Key health-care interventions can largely prevent these deaths, but their use is limited in developing countries, and is reported to vary between population groups. We reviewed the use of maternal health-care interventions in developing countries to assess the extent, strength and implications of evidence for variations according to women's place of residence and socioeconomic status. Studies with data on use of a skilled health worker at delivery, antenatal care in the first trimester of pregnancy and medical settings for delivery were assessed. We identified 30 eligible studies, 12 of which were of high or moderate quality, from 23 countries. Results of these studies showed wide variation in use of maternal health care. Methodological factors (e.g. inaccurate identification of population in need or range of potential confounders controlled for) played a part in this variation. Differences were also caused by factors related to health-care users (e.g. age, education, medical insurance, clinical risk factors) or to supply of health care (e.g. clinic availability, distance to facility), or by an interaction between such factors (e.g. perceived quality of care). Variation was usually framed by contextual issues relating to funding and organization of health care or social and cultural issues. These findings emphasize the need to investigate and assess context-specific causes of varying use of maternal health care, if safe motherhood is to become a reality in developing countries.
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Affiliation(s)
- Lale Say
- UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland.
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Mpembeni RN, Killewo JZ, Leshabari MT, Massawe SN, Jahn A, Mushi D, Mwakipa H. Use pattern of maternal health services and determinants of skilled care during delivery in Southern Tanzania: implications for achievement of MDG-5 targets. BMC Pregnancy Childbirth 2007; 7:29. [PMID: 18053268 PMCID: PMC2222241 DOI: 10.1186/1471-2393-7-29] [Citation(s) in RCA: 236] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Accepted: 12/06/2007] [Indexed: 11/17/2022] Open
Abstract
Background Almost two decades since the initiation of the Safe motherhood Initiative, Maternal Mortality is still soaring high in most developing countries. In 2000 WHO estimated a life time risk of a maternal death of 1 in 16 in Sub- Saharan Africa while it was only 1 in 2800 in developed countries. This huge discrepancy in the rate of maternal deaths is due to differences in access and use of maternal health care services. It is known that having a skilled attendant at every delivery can lead to marked reductions in maternal mortality. For this reason, the proportion of births attended by skilled health personnel is one of the indicators used to monitor progress towards the achievement of the MDG-5 of improving maternal health. Methods Cross sectional study which employed quantitative research methods. Results We interviewed 974 women who gave birth within one year prior to the survey. Although almost all (99.8%) attended ANC at least once during their last pregnancy, only 46.7% reported to deliver in a health facility and only 44.5% were assisted during delivery by a skilled attendant. Distance to the health facility (OR = 4.09 (2.72–6.16)), discussion with the male partner on place of delivery (OR = 2.37(1.75–3.22)), advise to deliver in a health facility during ANC (OR = 1.43 (1.25–2.63)) and knowledge of pregnancy risk factors (OR 2.95 (1.65–5.25)) showed significant association with use of skilled care at delivery even after controlling for confounding factors. Conclusion Use of skilled care during delivery in this district is below the target set by ICPD + of attaining 80% of deliveries attended by skilled personnel by 2005. We recommend the following in order to increase the pace towards achieving the MDG targets: to improve coverage of health facilities, raising awareness for both men and women on danger signs during pregnancy/delivery and strengthening counseling on facility delivery and individual birth preparedness.
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Affiliation(s)
- Rose Nm Mpembeni
- School of Public Health and Social Sciences, Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar-Es-Salaam, Tanzania.
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Dhakal S, Chapman GN, Simkhada PP, van Teijlingen ER, Stephens J, Raja AE. Utilisation of postnatal care among rural women in Nepal. BMC Pregnancy Childbirth 2007; 7:19. [PMID: 17767710 PMCID: PMC2075509 DOI: 10.1186/1471-2393-7-19] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Accepted: 09/03/2007] [Indexed: 11/10/2022] Open
Abstract
Background Postnatal care is uncommon in Nepal, and where it is available the quality is often poor. Adequate utilisation of postnatal care can help reduce mortality and morbidity among mothers and their babies. Therefore, our study assessed the utilisation of postnatal care at a rural community level. Methods A descriptive, cross-sectional study was carried out in two neighbouring villages in early 2006. A total of 150 women who had delivered in the previous 24 months were asked to participate in the study using a semi-structured questionnaire. Results The proportion of women who had received postnatal care after delivery was low (34%). Less than one in five women (19%) received care within 48 hours of giving birth. Women in one village had less access to postnatal care than women in the neighbouring one. Lack of awareness was the main barrier to the utilisation of postnatal care. The woman's own occupation and ethnicity, the number of pregnancies and children and the husband's socio-economic status, occupation and education were significantly associated with the utilisation of postnatal care. Multivariate analysis showed that wealth as reflected in occupation and having attended antenatal are important factors associated with the uptake of postnatal care. In addition, women experiencing health problems appear strongly motivated to seek postnatal care. Conclusion The postnatal care has a low uptake and is often regarded as inadequate in Nepal. This is an important message to both service providers and health-policy makers. Therefore, there is an urgent need to assess the actual quality of postnatal care provided. Also there appears to be a need for awareness-raising programmes highlighting the availability of current postnatal care where this is of sufficient quality.
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Affiliation(s)
- Sulochana Dhakal
- Department of Public Health, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Glyn N Chapman
- Department of Public Health, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Padam P Simkhada
- Department of Public Health, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | | | | | - Amalraj E Raja
- Department of Public Health, University of Aberdeen, Aberdeen, AB25 2ZD, UK
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Mrisho M, Schellenberg JA, Mushi AK, Obrist B, Mshinda H, Tanner M, Schellenberg D. Factors affecting home delivery in rural Tanzania. Trop Med Int Health 2007; 12:862-72. [PMID: 17596254 DOI: 10.1111/j.1365-3156.2007.01855.x] [Citation(s) in RCA: 186] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Studies of factors affecting place of delivery have rarely considered the influence of gender roles and relations within the household. This study combines an understanding of gender issues relating to health and help-seeking behaviour with epidemiological knowledge concerning place of delivery. METHODS In-depth interviews, focus group discussions and participant observation were used to explore determinants of home delivery in southern Tanzania. Quantitative data were collected in a cross-sectional survey of 21,600 randomly chosen households. RESULTS Issues of risk and vulnerability, such as lack of money, lack of transport, sudden onset of labour, short labour, staff attitudes, lack of privacy, tradition and cultures and the pattern of decision-making power within the household were perceived as key determinants of the place of delivery. More than 9000 women were interviewed about their most recent delivery in the quantitative survey. There were substantial variations between ethnic groups with respect to place of delivery (P<0.0001). Women who lived in male-headed households were less likely to deliver in a health facility than women in female-headed households (RR 0.86, 95% CI 0.80-0.91). Mothers with primary and higher education were more likely to deliver at a health facility (RR 1.30, 95% CI 1.23-1.38). Younger mothers and the least poor women were also more likely to deliver in a health facility compared with the older and the poorest women, respectively. CONCLUSIONS To address neonatal mortality, special attention should be paid to neonatal health in both maternal and child health programmes. The findings emphasize the need for a systematic approach to overcome health-system constraints, community based programmes and scale-up effective low-cost interventions which are already available.
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Affiliation(s)
- Mwifadhi Mrisho
- Ifakara Health Research and Development Centre, Dar es Salaam, Tanzania.
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Chowdhury RI, Islam MA, Gulshan J, Chakraborty N. Delivery complications and healthcare-seeking behaviour: the Bangladesh Demographic Health Survey, 1999-2000. HEALTH & SOCIAL CARE IN THE COMMUNITY 2007; 15:254-64. [PMID: 17444989 DOI: 10.1111/j.1365-2524.2006.00681.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Maternal health services have a potentially critical role in the improvement of reproductive health. The use of health services is related to the availability, quality and cost of the services, as well as to social structure, health beliefs and the personal characteristics of the users. The present paper examined the factors that influence the use of maternal health services for some selected pregnancy-related complications (e.g. prolonged labour, excessive bleeding, high fever/discharge and convulsions) in Bangladesh by using data from the Bangladesh Demographic Health Survey, 1999-2000. It was found that younger mothers were significantly less likely to seek professional healthcare at the time of birth. The odds for rural women seeking healthcare services from a doctor, nurse and/or midwife were half those of urban women. The strong influence of the mothers' education and parity on the utilisation of healthcare services is consistent with findings from other studies. The possession of assets emerged as an important predictor of seeking care from health professionals at the time of birth. Another factor, i.e. a husband's concern about pregnancy complications, showed a significant and positive impact on the utilisation of healthcare services, which is very important for rural women when they are dependent on their spouses. It was observed that the respondents living in urban areas, who had higher levels of education and lower parity, and more assets (used as a proxy for income), visited trained healthcare providers more often and were more likely to use healthcare facilities provided by trained personnel at the time of delivery. This is a reflection of the fact that, irrespective of their needs, only people from higher economic or educational groups can afford to seek healthcare from trained personnel in Bangladesh. In other words, predisposing and enabling factors appear to have a strong association with women's healthcare utilisation during pregnancy.
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Affiliation(s)
- Rafiqul I Chowdhury
- Department of Health Information Administration, Kuwait University, Jabriya, Kuwait.
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Onah HE, Ikeako LC, Iloabachie GC. Factors associated with the use of maternity services in Enugu, southeastern Nigeria. Soc Sci Med 2006; 63:1870-78. [PMID: 16766107 DOI: 10.1016/j.socscimed.2006.04.019] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2005] [Indexed: 10/24/2022]
Abstract
The maternal mortality ratio and other maternal health indicators are worse for developing countries than for the developed world due to improved access to quality care during pregnancy and especially at delivery in the industrialized world. This study was carried out to identify the factors which influenced choice of place of delivery by pregnant women in Enugu, southeastern Nigeria, and to recommend ways to improve women's access to skilled attendants at delivery. A pre-tested questionnaire was administered by interviewers to women who had delivered within 3 months prior to date of data collection. The response rate was 75.5% (n=1098). Of the respondents, 52.9% delivered outside health institutions and 47.1% in health institutions. The major factors influencing choice of place of delivery included promptness of care, competence of midwife/doctor, affordability, health education, 24 h presence of doctors, team work among doctors and presence of specialist obstetricians. There were statistically significant associations between choice of institutional or non-institutional deliveries and socio-demographic/economic factors such as place of residence (urban/rural), religion, educational status, tribe, marital status, occupational level, husband's occupational and educational levels, age and parity (p<0.05). We conclude that factors which will positively influence women to deliver in health institutions in Enugu, Nigeria include a variety of interacting social, economic and health system factors, which operate at various levels-the household, community, the health institutions and the larger social and political environment. Attention to these factors will not only improve maternity utilization but, hopefully, also will reduce the high maternal mortality and improve other maternal health indicators in the study area.
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Igberase GO, Ebeigbe PN. Eclampsia: ten-years of experience in a rural tertiary hospital in the Niger delta, Nigeria. J OBSTET GYNAECOL 2006; 26:414-7. [PMID: 16846866 DOI: 10.1080/01443610600720113] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Eclampsia is a major cause of maternal and perinatal morbidity and mortality in developing countries including Nigeria. However, most studies on eclampsia have been in urban communities. The objective of this study was to determine the incidence, pattern of clinical presentation and maternal and fetal outcomes of cases of eclampsia in a rural tertiary hospital in Nigeria. A descriptive review of all cases of eclampsia seen between 1 January 1994 and 31 December 2003 in a tertiary hospital was undertaken. The incidence of eclampsia was 1 in 43 deliveries (2.3%). Most of the women (86.2%) were unbooked for antenatal care in our centre; 58.5% were nullipara, and the onset of seizures was in the ante-partum period (68.3%). Patients presenting were mostly from the traditional birth attendants (46.3%). The time interval between the onset of convulsions and hospital admission was less than 12 h in 52% of cases. The majority of the women had premonitory symptoms (78.8%) with headache being the most frequent (78%). The major route of delivery was abdominal (66.7%). The case fatality rate was 15.4%. Most of the deaths (89.5%) were in unbooked women and the most common causes of death were acute renal failure, cardiopulmonary failure, disseminated intravascular coagulopathy and cerebrovascular accident. The perinatal mortality rate was 195 per 1000 births. This study found a high incidence of eclampsia. It is recommended that community-based health education programmes should be pursued with vigour to enhance early utilisation of modern antenatal care services in rural areas. Traditional birth attendants need to be trained and integrated into the healthcare team. Appropriate mechanisms should be put in place to improve clinic referrals. The capacity of tertiary health institutions to provide intensive care for eclamptics need to be improved with continuous training of heathcare personnel and provision of necessary equipment.
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Affiliation(s)
- G O Igberase
- Department of Obstetrics and Gynaecology, Baptist Medical Centre, Eku, Delta State, Nigeria.
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Ikeako LC, Onah HE, Iloabachie GC. Influence of formal maternal education on the use of maternity services in Enugu, Nigeria. J OBSTET GYNAECOL 2006; 26:30-4. [PMID: 16390706 DOI: 10.1080/01443610500364004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although some previous studies have suggested formal maternal education as the most potent tool for reducing the mortality ratio in Nigeria, other studies found that the depressed Nigerian economy since 1986 has marginalised the benefits of education with the result that educated women stopped making use of existing health facilities because they could not afford the cost of health services. This study was carried out to determine the current influence of formal maternal education and other factors on the choice of place of delivery by pregnant women in Enugu, south-eastern Nigeria. It was a pre-tested interviewer-administered questionnaire study of women who delivered within 3 months before the date of data collection in the study area. In an increasing order of level of care, the outcome variable (place where the last delivery took place) was categorised into seven, with home deliveries representing the lowest category and private hospitals run by specialist obstetricians as the highest category. These were further sub-categorised into non-institutional deliveries and institutional deliveries. Maternal educational level was the main predictor variable. Other predictor variables were sociodemographic factors. Data analysis was by means of descriptive and inferential statistics including means, frequencies and chi2-tests at the 95% confidence (CI) level. Out of a total of 1,450 women to whom the questionnaires were administered, 1,095 women responded (a response rate of 75.5%). A total of 579 (52.9%) of the respondents delivered outside health institutions, while the remaining 516 (47.1%) delivered within health institutions. Regarding the educational levels of the respondents, 301 (27.5%) had no formal education; 410 (37.4%) had primary education; 148 (13.5%) secondary education and 236 (21.5%) post-secondary education. There was a significant positive correlation between the educational levels of the respondents and their husbands (r=0.86, p=0.000). With respect to occupational categories of the respondents, 88 (8.0%) of them belonged to occupational class I, 158 (14.4%) to occupational class II, 107 (9.8%) to occupational class III, 14 (1.3%) to occupational class IV and 728 to occupational class V. There was a significant positive correlation between the respondents' and their husbands' occupational levels (r=0.89, p=0.000). There were statistically significant associations between choice of institutional or non-institutional deliveries and respondents' educational level as well as place of residence (urban/rural), religion, tribe, marital status, occupational level, husband's occupational and educational levels, age and parity (p<or=0.05 for each variable). Further analysis of only the respondents who delivered within health institutions showed that there was a significant positive correlation between their educational levels and the level of care where they delivered (r=0.45, p=0.000). Significantly more of them with post-secondary education lived in the urban than in the rural areas, were Christians and were married to husbands of higher educational and economic levels. It is concluded that formal education is still a significant predictor of whether women deliver within or outside health institutions in Enugu, south- eastern Nigeria. Efforts at reducing maternal mortality ratio in Nigeria must increase the adult female literacy rate.
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Affiliation(s)
- L C Ikeako
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria
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Abstract
Indonesia has set an ambitious target of reducing its maternal mortality rate to 125 maternal deaths per 100,000 live births by the year 2010. This poses formidable challenges in a geographically diverse country where the majority of births occur at home. One option for the Indonesian government in order to reduce its maternal mortality would be to increase rates of skilled assistance for home deliveries. In order to design appropriate policies to achieve this, it is imperative to understand the determinants of use of birth attendants by mothers delivering at home. We use the Andersen Behavioral Model as a theoretical framework to understand the determinants of the use of a trained provider, traditional birth attendant, or no trained assistance during home deliveries in Indonesia. The 1997 Indonesia Demographic and Health Survey (IDHS) was used, and data from the most recent home delivery was abstracted for analysis. Out of a total sample of 10,692 home deliveries, a majority (53%) used the services of a TBA, 40% had a doctor, nurse or midwife in attendance, and only 7% delivered with the help of family and/or friends. A multinomial logit model was used to predict determinants of use. Our results indicate that maternal education, religion, asset index quartile and number of antenatal visits are significant determinants among all choice sets.
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Affiliation(s)
- Amardeep Thind
- Department of Health Services, UCLA School of Public Health, Los Angeles, CA 90095-1772, USA.
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Wagle RR, Sabroe S, Nielsen BB. Socioeconomic and physical distance to the maternity hospital as predictors for place of delivery: an observation study from Nepal. BMC Pregnancy Childbirth 2004; 4:8. [PMID: 15154970 PMCID: PMC425583 DOI: 10.1186/1471-2393-4-8] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2003] [Accepted: 05/22/2004] [Indexed: 11/12/2022] Open
Abstract
Background Although the debate on the safety and women's right of choice to a home delivery vs. hospital delivery continues in the developed countries, an undesirable outcome of home delivery, such as high maternal and perinatal mortality, is documented in developing countries. The objective was to study whether socio-economic factors, distance to maternity hospital, ethnicity, type and size of family, obstetric history and antenatal care received in present pregnancy affected the choice between home and hospital delivery in a developing country. Methods This cross-sectional study was done during June, 2001 to January 2002 in an administratively and geographically well-defined territory with a population of 88,547, stretching from urban to adjacent rural part of Kathmandu and Dhading Districts of Nepal with maximum of 5 hrs of distance from Maternity hospital. There were no intermediate level of private or government hospital or maternity homes in the study area. Interviews were carried out on 308 women who delivered within 45 days of the date of the interview with a pre-tested structured questionnaire. Results A distance of more than one hour to the maternity hospital (OR = 7.9), low amenity score status (OR = 4.4), low education (OR = 2.9), multi-parity (OR = 2.4), and not seeking antenatal care in the present pregnancy (OR = 4.6) were statistically significantly associated with an increased risk of home delivery. Ethnicity, obstetric history, age of mother, ritual observance of menarche, type and size of family and who is head of household were not statistically significantly associated with the place of delivery. Conclusions The socio-economic standing of the household was a stronger predictor of place of delivery compared to ethnicity, the internal family structure such as type and size of family, head of household, or observation of ritual days by the mother of an important event like menarche. The results suggested that mothers, who were in the low-socio-economic scale, delivered at home more frequently in a developing country like Nepal.
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Affiliation(s)
- Rajendra Raj Wagle
- Department of Epidemiology and Social Medicine, University of Aarhus, 8000 Aarhus C, Denmark
| | - Svend Sabroe
- Department of Epidemiology and Social Medicine, University of Aarhus, 8000 Aarhus C, Denmark
| | - Birgitte Bruun Nielsen
- Perinatal Epidemiological Research Unit, Department of Obstetrics and Gynaecology, Aarhus University Hospital, 8200 Aarhus N, Denmark
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Stephenson R, Tsui AO. Contextual influences on reproductive health service use in Uttar Pradesh, India. Stud Fam Plann 2002; 33:309-20. [PMID: 12561780 DOI: 10.1111/j.1728-4465.2002.00309.x] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study examines the determinants of the use of four types of reproductive health-care services in Uttar Pradesh, India: contraceptive services, antenatal care, delivery in a medical institution, and services dealing with reproductive tract and sexually transmitted infections. The analysis uses a multilevel modeling strategy to assess the presence of household- and community-level variation in service use. The influence of community-level characteristics and reproductive health-care service attributes on service use is examined. The results highlight strong community-level influences on service use, although the type of community effect varies by service type. The role of some individual and household factors in determining a person's use of services is mediated by the characteristics of the community in which the individual lives. The results demonstrate the need to look beyond individual factors when examining health-care-seeking behavior, and illustrate that there is no singular "community" effect on service use.
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Affiliation(s)
- Rob Stephenson
- Bill and Melinda Gates Institute for Population and Reproductive Health, Department of Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205-2179, USA.
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Ishikawa N, Simon K, Porter JDH. Factors affecting the choice of delivery site and incorporation of traditional birth customs in a refugee camp, Thailand. Int J Gynaecol Obstet 2002; 78:55-7. [PMID: 12113973 DOI: 10.1016/s0020-7292(02)00067-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- N Ishikawa
- Japan International Cooperation Agency, Beijing, China.
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Abioye-Kuteyi EA, Elias SO, Familusi AF, Fakunle A, Akinfolayan K. The role of traditional birth attendants in Atakumosa, Nigeria. THE JOURNAL OF THE ROYAL SOCIETY FOR THE PROMOTION OF HEALTH 2001; 121:119-24. [PMID: 11467204 DOI: 10.1177/146642400112100214] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
All 26 traditional birth attendants (TBAs) and their 109 clients in 15 settlements in Atakumosa West Local Government Area (LGA) in Nigeria were interviewed to assess TBA training, practices and utilisation. The study showed that more than 80% of TBAs were older women with more than four children, practiced single-handedly and held other occupations. About 54% of those studied had no designated room for deliveries; twenty-one (80.8%) did not consider any pregnant woman to be at high risk; three (11.5%) perform intravaginal examinations during labour and only a few recognise complications; twelve (46.2%) never refer patients. Despite these deficiencies, TBAs continue to practise in appreciable numbers and their services continue to be on demand in the communities under study. Nearly all of the clients interviewed had started to use TBAs by the age of 25 and 50% had used TBAs for all of their deliveries. Most TBAs provide antenatal care and 77% had a case load of less than five clients per month. Ninety-six per cent of the clients had not been referred by the TBA before. Although 61% of clients felt TBAs in a future pregnancy and 49% would recommend TBA care to other women. Low socio-economic status, illiteracy, poor awareness of modern maternal health (MCH) facilities, personalized care, strong family influence and easy access to TBA services were strong factors promoting traditional midwifery in the LGA. If adequately trained, equipped, supported and supervised, TBAs can contribute towards safe motherhood in Nigeria and in other developing countries.
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Affiliation(s)
- E A Abioye-Kuteyi
- Department of Community Health, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria.
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Stephens TT, Oriuwa CL. Child Survival and Baseline Surveys: A Description of Literacy Rates of Women of Child Bearing Age in Abia and Imo States, Nigeria. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 1996; 16:79-90. [DOI: 10.2190/19f3-b0cu-8q1f-u163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The results of a literacy need assessment conducted in eight autonomous communities, four from both Abia and Imo States, is presented and discussed. Data were obtained via survey interview and administered to 209 and 235 subjects respectively for Abia and Imo States. The information was collected to form a baseline level of operation prior to the Literacy for Health Intervention implemented by Africare/Owerri and the Imo State Ministry of Health. Results suggest both similar and varied trends regarding literacy abilities of participants and their attitudes regarding adult literacy instruction in the samples from both communities. This study emphasizes the literacy needs items of the survey. Findings support the need for literacy for health interventions in these areas and confirm the need for interventions to improve literacy skills and enhance the quality of life of families living in these communities. It is anticipated that data obtained regarding baseline assessments and interviews may be used to examine the long-term effectiveness and impact of literacy for health care activities under the auspices of child survival projects.
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