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Huda M, Ali T, Hasnani FB, Sayani S, Zaidi S. Predictors of Uptake of Rotavirus Vaccination Amongst Disadvantaged Communities in Pakistan. Glob Pediatr Health 2024; 11:2333794X241235746. [PMID: 38465209 PMCID: PMC10924542 DOI: 10.1177/2333794x241235746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 01/16/2024] [Accepted: 02/12/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction. Pakistan has the highest childhood mortality associated with diarrheal diseases. The objective of this study is to identify underlying factors contributing to lack of knowledge among mothers regarding vaccine's efficacy in the prevention of diarrhea. Methodology. Secondary data was analyzed from a cross-sectional household survey in Northern Pakistan of eligible households having under-2-year children. Univariate and multivariate logistic regression analyses were carried out. Results. Only 30% of the mothers had knowledge regarding diarrhea prevention by vaccine. The main factors found significantly correlated with this knowledge were mother's education, distance of households from EPI centers, immunization status of children, counseling regarding clean drinking water and hygiene, provision of ORS, and antenatal care services by LHWs. Conclusion. Women's literacy, access to care and LHW services are important for improving awareness and acceptance of vaccines for vaccine preventable diseases including diarrhea. Policy makers need to focus on improved monitoring and reprioritization of undermined services by LHWs.
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Constantine A, Fantaye AW, Buh A, Obegu P, Fournier K, Kasonde M, Jacobs C, Clementina P, Gobina R, Kibu O, Foretia D, Nkangu M, Yaya S. Utilisation of mobile phone interventions to improve the delivery of maternal health services in sub-Saharan Africa: A scoping review protocol. PLoS One 2024; 19:e0295437. [PMID: 38446819 PMCID: PMC10917244 DOI: 10.1371/journal.pone.0295437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/20/2023] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION There has been significant progress in maternal health outcomes in the sub-Saharan African region since the early 1990s, in part due to digital and mobile health interventions. However, critical gaps and disparities remain. Mobile phones in particular have potential to reach underserved, hard-to-reach populations with underdeveloped infrastructure. In spite of the opportunities for mobile phones to address maternal mortality in the region, there is no extensive mapping of the available literature on mobile phone interventions that aim to improve access of maternal care in sub-Saharan Africa. The proposed scoping review aims to map literature on the nature and extent of mobile phones interventions designed to improve maternal care health services in the region. METHODS Conduct of this scoping review will be guided by the Joanna Briggs Institute approach. Literature searches will be conducted in multiple electronic databases, including MEDLINE, Embase, CINAHL, APA PsycInfo, Cochrane Central Register of Controlled Trials, Global Health, African Index Medicus, Web of Science, and Applied Social Sciences Index & Abstracts. Grey literature will also be identified. Keyword searches will be used to identify articles. Two reviewers will independently screen eligible titles, abstracts and full articles with a third reviewer to help resolve any disputes. We will extract data on general study characteristics, population characteristics, concept, context, intervention details, study results, gaps and recommendations. DISCUSSION Understanding use of mobile phones among underserved, hard-to-reach populations with underdeveloped infrastructure to address maternal mortality in developing countries is very critical to informing health systems on potential effective strategies. This review will complement the evidence base on utilisation of mobile phone interventions to improve the delivery of maternal health services in sub-Saharan Africa.
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Affiliation(s)
- Asahngwa Constantine
- Nkafu Policy Institute, Denis and Lenora Foretia Foundation Cameroon, Yaounde, Cameroon
| | | | - Amos Buh
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Pamela Obegu
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Karine Fournier
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
| | - Mwenya Kasonde
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Choolwe Jacobs
- School of Public Health, University of Zambia, Lusaka, Zambia
| | | | - Ronald Gobina
- Nkafu Policy Institute, Denis and Lenora Foretia Foundation Cameroon, Yaounde, Cameroon
| | - Odette Kibu
- Nkafu Policy Institute, Denis and Lenora Foretia Foundation Cameroon, Yaounde, Cameroon
| | - Denis Foretia
- Nkafu Policy Institute, Denis and Lenora Foretia Foundation Cameroon, Yaounde, Cameroon
- Center for Multicultural and Global Health, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Miriam Nkangu
- Bruyere Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Health, Imperial College London, London, United Kingdom
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Gebremeskel AT, Udenigwe O, Etowa J, Yaya S. Unpacking the challenges of fragmentation in community-based maternal newborn and child health and health system in rural Ethiopia: A qualitative study. PLoS One 2023; 18:e0291696. [PMID: 37733782 PMCID: PMC10513239 DOI: 10.1371/journal.pone.0291696] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/22/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION In Ethiopia, country-wide community-based primary health programs have been in effect for about two decades. Despite the program's significant contribution to advancing Maternal Newborn and Child Health (MNCH), Ethiopia's maternal and child mortality is still one of the highest in the world. The aim of this manuscript is to critically examine the multifaceted fragmentation challenges of Ethiopia's Community Health Workers (CHWs) program to deliver optimum MNCH and build a resilient community health system. METHODS We conducted a qualitative case study in West Shewa Zone, rural Ethiopia. A purposive sampling technique was used to recruit participants. Data sources were two focus group discussions with sixteen CHWs, twelve key informant interviews with multilevel public health policy actors, and a policy document review related to the CHW program to triangulate the findings. Thematic analysis of the qualitative data was conducted. The World Health Organization's health systems framework and socio-ecological model guided the data collection, analysis, and interpretation. RESULTS The CHWs program has been an extended arm of Ethiopia's primary health system and has contributed to improved health outcomes. However, the program has been facing unique systemic challenges that stem from the fragmentation of health finance; medical and equipment supply; working and living infrastructures; CHWs empowerment and motivation, monitoring, supervision, and information; coordination and governance; and community and stakeholder engagement. The ongoing COVID-19 and volatile political and security issues are exacerbating these fragmentation challenges. CONCLUSION This study emphasized the gap between the macro (national) level policy and the challenge during implementation at the micro (district)level. Fragmentation is a blind spot for the community-based health system in rural Ethiopia. We argue that the fragmentation challenges of the community health program are exacerbating the fragility of the health system and fragmentation of MNCH health outcomes. This is a threat to sustain the MNCH outcome gains, the realization of national health goals, and the resilience of the primary health system in rural Ethiopia. We recommend that beyond the current business-as-usual approach, it is important to emphasize an evidence-based and systemic fragmentation monitoring and responsive approach and to better understand the complexity of the community-based health system fragmentation challenges to sustain and achieve better health outcomes. The challenges can be addressed through the adoption of transformative and innovative approaches including capitalizing on multi-stakeholder engagement and health in all policies in the framework of co-production.
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Affiliation(s)
- Akalewold T. Gebremeskel
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- School of Nursing, Faculty of Health Sciences University of Ottawa, Ottawa, Ontario, Canada
| | - Ogochukwu Udenigwe
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
| | - Josephine Etowa
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- School of Nursing, Faculty of Health Sciences University of Ottawa, Ottawa, Ontario, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Health, Imperial College London, London, United Kingdom
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Ahmed KT, Karimuzzaman M, Mahmud S, Rahman L, Hossain MM, Rahman A. Influencing factors associated with maternal delivery at home in urban areas: a cross-sectional analysis of the Bangladesh Demographic and Health Survey 2017-2018 data. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:83. [PMID: 37605266 PMCID: PMC10440937 DOI: 10.1186/s41043-023-00428-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/11/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND The associated factors and patterns of giving birth in home settings of rural areas have been extensively studied in Bangladeshi literature. However, urban areas still need to be explored, particularly with recent data. Therefore, the authors aimed to investigate the influential determinants of delivery at home in urban areas of Bangladesh. MATERIALS AND METHODS In this study, 1699 urban-dwelling women who had given birth within the previous 60 months of the survey and lived in urban areas were used. The secondary data were extracted from the latest Bangladesh Demographic and Health Survey 2017-2018. Descriptive statistics and logistic regression were applied along with the association among selected variables were examined by the Chi-square test. RESULTS Findings depict that 36.49% of women who lived in urban areas of Bangladesh delivered at home, whereas, 63.51% delivered at different govt. and private health care facilities. Women who lived in Chittagong [adjusted odds ratio (AOR) = 2.11, 95% CI 1.24-3.60], Barisal [AOR = 2.05, 95% CI 1.16-3.64] and Sylhet [AOR = 1.92, 95% CI 1.08-3.43] divisions have more likelihood to deliver at home (36.85%). Urban women following Christian religion [AOR = 10.71, 95% CI 1.32-86.68] have higher odds of delivering child at home (0.47%). Urban women having three or more children before her latest delivery (22.37%) and who are employed (29.37%) have more likelihood to deliver at home. However, women aged between 25 and 34 years (43.50%), who have higher education (25.90%), play the role of household head (9.06%), have parity of more than two births (2.24%), and read daily newspapers (68.69%) had a lower chance of delivery at home. Furthermore, women from wealthier families (89.12%) and more antenatal care (ANC) visits (94.93%) were less likely to have a delivery at home. CONCLUSION Despite significant progress in women and reproductive health in Bangladesh, the proportion of delivery in the home in urban areas is alarming and should be emphasized more. The authors believe the identified factors will help design interventions and policy development on this issue.
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Affiliation(s)
| | - Md Karimuzzaman
- DREXEL Dornsife School of Public Health, DREXEL University, Philadelphia, PA, USA
| | - Shohel Mahmud
- Department of Statistics, Noakhali Science and Technology University, Noakhali, 3814, Bangladesh
| | - Labiba Rahman
- Department of Statistics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Md Moyazzem Hossain
- Department of Statistics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh.
- School of Mathematics, Statistics, and Physics, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK.
| | - Azizur Rahman
- School of Computing, Mathematics and Engineering, Charles Sturt University, Wagga Wagga, NSW, 2678, Australia
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Jacobs C, Michelo C, Hyder A. Understanding maternal choices and experiences of care by skilled providers: Voices of mothers who delivered at home in selected communities of Lusaka city, Zambia. Front Glob Womens Health 2023; 3:916826. [PMID: 36683603 PMCID: PMC9852978 DOI: 10.3389/fgwh.2022.916826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 11/22/2022] [Indexed: 01/09/2023] Open
Abstract
Background Significant proportions of women living in urban areas including the capital cities continue to deliver at home. We aimed to understand why mothers in a selected densely populated community of Lusaka city in Zambia deliver from home without assistance from a skilled provider during childbirth. Methods Using a phenomenological case study design, we conducted Focus Group Discussions and In-depth Interviews with mothers who delivered at home without assistance from a skilled provider. The study was conducted between November 2020 and January 2021 among 19 participants. Data were analysed using content analysis. Results Individual-related factors including the belief that childbirth is a natural and easy process that did not require assistance, lack of transport to get to the health facility, influence and preference for care from older women who were perceived to have the experience and better care, failure to afford baby supplies, and waiting for partner to provide the supplies that were required at the health facility influenced mothers' choices to seek care from skilled providers. Health system-related factors included mistreatment and disrespectful care such as verbal and physical abuse by skilled healthcare providers, stigma and discrimination, institutional fines, and guidelines such as need to attend antenatal care with a spouse and need to provide health facility demanded supplies. Conclusion Individual and health system access related factors largely drive the choice to involve skilled providers during childbirth. The socioeconomic position particularly contributes to limited decision-making autonomy of mothers, thus, creating challenges to accessing care in health facilities. The health system-related factors found in this study such as mistreatment and disrespectful care suggests the need for redesigning effective and sustainable urban resource-limited context maternal health strategies that are culturally acceptable, non-discriminatory, and locally responsive and inclusive. Rethinking these strategies this way has the potential to strengthening equitable responsive health systems that could accelerate attainment of sustainable developmental goal (SDG) 3 targets.
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Affiliation(s)
- Choolwe Jacobs
- School of Public Health, University of Zambia, Lusaka, Zambia,Correspondence: Choolwe Jacobs
| | - Charles Michelo
- Harvest Research Institutes, Harvest University, Lusaka, Zambia
| | - Adnan Hyder
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States
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Alem AZ, Shitu K, Alamneh TS. Coverage and factors associated with completion of continuum of care for maternal health in sub-Saharan Africa: a multicountry analysis. BMC Pregnancy Childbirth 2022; 22:422. [PMID: 35590260 PMCID: PMC9121540 DOI: 10.1186/s12884-022-04757-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/13/2022] [Indexed: 01/18/2023] Open
Abstract
Background Many maternal and neonatal deaths are largely preventable by expanding the continuum of care (at least four antenatal visits, skilled birth attendance and postnatal care). Even though ensuring the Continuum of Care (CoC) has advantages over separate services, evidence from the globe suggests that completion of the CoC for maternal health is very low. From our search of the literature, there is limited evidence on the completion of the entire CoC and its associated factors in sub-Saharan Africa (sSA). Therefore, this study aimed to assess coverage and associated factors of completion of the CoC for maternal health in sSA. Methods Data for the study were drawn from a recent nationally representative survey of 32 Demographic and Health Surveys (DHS). A total weighted sample of 225,135 women of reproductive-age, who gave birth in the two preceding years were included. Due to the hierarchical nature of DHS data, a multilevel logistic regression model was applied to investigate individual and community-level factors that may influence completion of CoC. Adjusted Odds Ratios (aORs) with 95% Confidence Interval (CI) were reported and variables with 95% CI not including 1 were considered as significant factors of the completion of CoC. Results Only, 56,172 (25.0%; 95% CI, 20.5%, 29.4%) of the women in sSA utilized the CoC for maternal health which varied from 11,908 (17.9.0%) in East Africa to 7,418 (51.5% in Southern Africa. Factors associated with higher odds of CoC were women aged 24–34 years (aOR 1.22, 95% CI: 1.17, 1.25), aged ≥ 35 years (aOR 1.40, 95% CI: 1.35, 1.47), attending primary education (aOR 1.44, 95% CI: 1.41, 1.49), secondary education (aOR 1.95, 95% CI: 1.89, 2.03), higher education (aOR 2.15, 95% CI: 2.01, 2.25), having mass media exposure (aOR 1.35, 95% CI: 1.28, 1.39), women from female-headed households (aOR 1.18, 95% CI: 1.15, 1.21) and women from communities with high maternal education (aOR 1.12, 95% CI: 1.09, 1.16). However, perceiving distance from the health facility as a big problem (aOR 0.88, 95% CI: 0.85, 0.91), residing in rural areas (aOR 0.78, 95% CI: 0.75, 0.81), delayed ANC initiation (aOR 0.43, 95% CI: 0.41, 0.47) and unintended pregnancy (aOR 0.87, 95% CI: 0.84, 0.91) were associated with lower odds of CoC. Conclusion This study showed a low proportion of women, who utilized the CoC in sSA. Both individual and community-level factors were associated with CoC completion rates among women in sSA. Therefore, policymakers in sSA must consider both individual and community-level factors and undertake multi-sectorial approaches to address barriers of CoC at different levels. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04757-1.
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Affiliation(s)
- Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Kegnie Shitu
- Department of Health Education and Behavioral Science, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tesfa Sewunet Alamneh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Gandhi S, Dash U, Suresh Babu M. Horizontal inequity in the utilisation of Continuum of Maternal Health care Services (CMHS) in India: an investigation of ten years of National Rural Health Mission (NRHM). Int J Equity Health 2022; 21:7. [PMID: 35033087 PMCID: PMC8760767 DOI: 10.1186/s12939-021-01602-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 12/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Continuum of Maternal Health Care Services (CMHS) has garnered attention in recent times and reducing socio-economic disparity and geographical variations in its utilisation becomes crucial from an egalitarian perspective. In this study, we estimate inequity in the utilisation of CMHS in India between 2005 and 06 and 2015-16. METHODS We used two rounds of National Family Health Survey (NFHS) - 2005-06 and 2015-16 encompassing a sample size of 34,560 and 178,857 pregnant women respectively. The magnitude of horizontal inequities (HI) in the utilisation of CMHS was captured by adopting the Erreygers Corrected Concentration indices method. Need-based standardisation was conducted to disentangle the variations in the utilisation of CMHS across different wealth quintiles and state groups. Further, a decomposition analysis was undertaken to enumerate the contribution of legitimate and illegitimate factors towards health inequity. RESULTS The study indicates that the pro-rich inequity in the utilisation of CMHS has increased by around 2 percentage points since the implementation of National Rural Health Mission (NRHM), where illegitimate factors are dominant. Decomposition analysis reveals that the contribution of access related barriers plummeted in the considered period of time. The results also indicate that mother's education and access to media continue to remain major contributors of pro-rich inequity in India. Considering, regional variations, it is found that the percentage of pro-rich inequity in high focus group states increased by around 3% between 2005 and 06 and 2015-16. The performance of southern states of India is commendable. CONCLUSIONS Our study concludes that there exists a pro-rich inequity in the utilisation of CMHS with marked variations across state boundaries. The pro-rich inequity in India has increased between 2005 and 06 and high focus group states suffered predominantly. Decentralisation of healthcare policies and granting greater power to the states might lead to equitable distribution of CMHS.
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Affiliation(s)
- Sumirtha Gandhi
- Bengaluru Dr. B.R. Ambedkar School of Economics, Bengaluru, Karnataka, India.
| | - Umakant Dash
- Institute of Rural Management, Anand, Gujarat, India
| | - M Suresh Babu
- Department of Humanities and Social Sciences, Indian Institute of Technology, Chennai, India
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Kim C, Erim D, Natiq K, Salehi AS, Zeng W. Combination of Interventions Needed to Improve Maternal Healthcare Utilization: A Multinomial Analysis of the Inequity in Place of Childbirth in Afghanistan. Front Glob Womens Health 2021; 1:571055. [PMID: 34816155 PMCID: PMC8594015 DOI: 10.3389/fgwh.2020.571055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 11/19/2020] [Indexed: 11/17/2022] Open
Abstract
Giving birth with a skilled birth attendant at a facility that provides emergency obstetric care services has better outcomes, but many women do not have access to these services in low- and middle-income countries. Individual, household, and societal factors influence women's decisions about place of birth. Factors influencing birthplace preference by type of provider and level of public facility are not well understood. Applying the Andersen Behavioral Model of healthcare services use, we explored the association between characteristics of women and their choice of childbirth location using a multinomial logistic regression, and conducted a scenario analysis to predict changes in the childbirth location by imposing various interventions. Most women gave birth at home (68.1%), while 15.1% gave birth at a public clinic, 12.1% at a public hospital, and 4.7% at a private facility. Women with higher levels of education, from households in the upper two wealth quintiles, and who had any antenatal care were more likely to give birth in public or private facilities than at home. A combination of multisector interventions had the strongest signals from the model for increasing the predicted probability of in-facility childbirths. This study enhances our understanding of factors associated with the use of public facilities and the private sector for childbirth in Afghanistan. Policymakers and healthcare providers should seek to improve equity in the delivery of health services. This study highlights the need for decisionmakers to consider a combination of multisector efforts (e.g., health, education, and social protection), to increase equitable use of maternal healthcare services.
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Affiliation(s)
- Christine Kim
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Daniel Erim
- Health Economics and Outcomes Research (HEOR) Modeling and Advanced Analytics, Parexel International, Durham, NC, United States
| | - Kayhan Natiq
- Silk Route Training and Research Organization, Kabul, Afghanistan
| | - Ahmad Shah Salehi
- Department of Global Health Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Wu Zeng
- Department of International Health, School of Nursing & Health Studies, Georgetown University, Washington, DC, United States
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Colomé-Hidalgo M, Campos JD, de Miguel ÁG. Exploring wealth-related inequalities in maternal and child health coverage in Latin America and the Caribbean. BMC Public Health 2021; 21:115. [PMID: 33423659 PMCID: PMC7798299 DOI: 10.1186/s12889-020-10127-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/23/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Maternal and child health have shown important advances in the world in recent years. However, national averages indicators hide large inequalities in access and quality of care in population subgroups. We explore wealth-related inequalities affecting health coverage and interventions in reproductive, maternal, newborn, and child health in Latin America and the Caribbean. METHODS We analyzed representative national surveys from 15 countries conducted between 2001 and 2016. We estimated maternal-child health coverage gaps using the Composite Coverage Index - a weighted average of interventions that include family planning, maternal and newborn care, immunizations, and treatment of sick children. We measured absolute and relative inequality to assess gaps by wealth quintile. Pearson's correlation coefficient was used to test the association between the coverage gap and population attributable risk. RESULTS The Composite Coverage Index showed patterns of inequality favoring the wealthiest subgroups. In eight countries the national coverage was higher than the global median (78.4%; 95% CI: 73.1-83.6) and increased significantly as inequality decreased (Pearson r = 0.9; p < 0.01). CONCLUSIONS There are substantial inequalities between socioeconomic groups. Reducing inequalities will improve coverage indicators for women and children. Additional health policies, programs, and practices are required to promote equity.
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Affiliation(s)
| | | | - Ángel Gil de Miguel
- Instituto Tecnológico de Santo Domingo, Universidad Rey Juan Carlos, Madrid, Spain
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Ahinkorah BO, Seidu AA, Budu E, Agbaglo E, Appiah F, Adu C, Archer AG, Ameyaw EK. What influences home delivery among women who live in urban areas? Analysis of 2014 Ghana Demographic and Health Survey data. PLoS One 2021; 16:e0244811. [PMID: 33395424 PMCID: PMC7781474 DOI: 10.1371/journal.pone.0244811] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/16/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In Ghana, home delivery among women in urban areas is relatively low compared to rural areas. However, the few women who deliver at home in urban areas still face enormous risk of infections and death, just like those in rural areas. The present study investigated the factors associated with home delivery among women who live in urban areas in Ghana. MATERIALS AND METHODS Data for this study was obtained from the 2014 Ghana Demographic and Health Survey. We used data of 1,441 women who gave birth in the 5 years preceding the survey and were dwelling in urban areas. By the use of Stata version 14.2, we conducted both descriptive and multivariable logistic regression analyses. RESULTS We found that 7.9% of women in urban areas in Ghana delivered at home. The study revealed that, compared to women who lived in the Northern region, women who lived in the Brong Ahafo region [AOR = 0.38, CI = 0.17-0.84] were less likely to deliver at home. The likelihood of home delivery was high among women in the poorest wealth quintile [AOR = 2.02, CI = 1.06-3.86], women who professed other religions [AOR = 3.45; CI = 1.53-7.81], and those who had no antenatal care visits [AOR = 7.17; 1.64-31.3]. Conversely, the likelihood of home delivery was lower among women who had attained secondary/higher education [AOR = 0.30; 0.17-0.53], compared to those with no formal education. CONCLUSION The study identified region of residence, wealth quintile, religion, antenatal care visits, and level of education as factors associated with home delivery among urban residents in Ghana. Therefore, health promotion programs targeted at home delivery need to focus on these factors. We also recommend that a qualitative study should be conducted to investigate the factors responsible for the differences in home delivery in terms of region, as the present study could not do so.
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Affiliation(s)
- Bright Opoku Ahinkorah
- The Australian Centre for Public and Population Health Research (ACPPHR), Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- * E-mail:
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Francis Appiah
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Collins Adu
- Department of Health Promotion and Disability Study, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anita Gracious Archer
- School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Edward Kwabena Ameyaw
- The Australian Centre for Public and Population Health Research (ACPPHR), Faculty of Health, University of Technology Sydney, Sydney, Australia
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Mihret H, Atnafu A, Gebremedhin T, Dellie E. Reducing Disrespect and Abuse of Women During Antenatal Care and Delivery Services at Injibara General Hospital, Northwest Ethiopia: A Pre-Post Interventional Study. Int J Womens Health 2020; 12:835-847. [PMID: 33116933 PMCID: PMC7568622 DOI: 10.2147/ijwh.s273468] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/25/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Disrespect and abuse during pregnancy and childbirth continue to be a barrier for the utilization and quality of care in maternal health services. This study was therefore aimed at reducing the disrespect and abuse of mothers during antenatal care and delivery services at Injibara general hospital, northwest Ethiopia. Materials and Methods A pre–post interventional mixed method design was conducted among a total of 738 randomly selected mothers who attended antenatal care and delivery services from November 1, 2018 to May 20, 2019. To collect the data, exit interview using an interviewer-administered structured questionnaire was used. Provision of training, preparation of standard written guidelines and protocols, waiting room construction, availing screening or curtain, equipment, essential drugs and supplies, supportive supervision and mentoring, and staff motivation were the lists of interventions applied to decrease disrespect and abuse. Descriptive statistics and independent t-test were computed. The independanet t-test is used because the study populations at the baseline and endline were different. A p-value of <0.05 and a mean difference with 95% CI was used to test the significance of the interventions. Results The study revealed that disrespect and abuse during pregnancy and childbirth decreased from 71.8% at baseline to 15.9% at the end-line with a 55.9% change (mean difference: 0.56, 95% CI: 0.55–0.57). Alongside, the magnitude on the subscales of disrespect and abuse (physical abuse, non-consented care, non-confidential care, non-dignified care, discrimination and neglected care) was decreased at post-intervention, compared with the baseline. Conclusion Respectful maternal healthcare after the intervention was significantly improved. The finding suggests that provision of training to healthcare providers, written policies and procedures that describe the responsibilities of healthcare providers in the respectful maternal care process, improving facility infrastructure, availing supplies, regular supportive supervision and mentoring and motivation of high-performance employees have the potential to enhance respectful maternal care. Therefore, incorporating such training into pre-service curricula and in‐service training of healthcare workers may indorse the practice of respectful maternal care.
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Affiliation(s)
- Habtamu Mihret
- Injibara General Hospital, Awi Zone administration, Amhara National Regional State, Injibara, Ethiopia
| | - Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tsegaye Gebremedhin
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Endalkachew Dellie
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Góes FGB, Silva MDA, Santos ASTD, Pontes BF, Lucchese I, Silva MTD. Postnatal care of newborns in the family context: an integrative review. Rev Bras Enferm 2020; 73:e20190454. [PMID: 32965418 DOI: 10.1590/0034-7167-2019-0454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/27/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to analyze the postnatal care practices of newborns in the family context from the scientific literature. METHODS the searches of the integrative literature review were carried out in the Latin American and Caribbean Literature in Health Sciences (LILACS), Nursing Database (BDENF), Scientific Electronic Library Online (SciELO), and U.S. National Library of Medicine (PubMed) databases. RESULTS sixteen studies composed the final sample and, from these, two analytical categories emerged: Practices and doubts of families in postnatal care of newborns; and Best practices in postnatal care of newborns. FINAL CONSIDERATIONS several cultural practices of families differ from scientific recommendations, which can generate risks to the health of newborns. Therefore, it is essential to consolidate educational programs with family members, to improve the quality of care offered and to reduce preventable neonatal deaths in different socio-family contexts.
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Affiliation(s)
| | | | | | | | - Ingrid Lucchese
- Universidade Federal Fluminense. Rio das Ostras, Rio de Janeiro, Brazil
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13
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Determinants of the Continuum of Maternal Healthcare Services in Northwest Ethiopia: Findings from the Primary Health Care Project. J Pregnancy 2020; 2020:4318197. [PMID: 32908704 PMCID: PMC7471826 DOI: 10.1155/2020/4318197] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 06/29/2020] [Indexed: 11/17/2022] Open
Abstract
Background The maternity continuum of care is the continuity of maternal healthcare services that a woman uses, which includes antenatal care (ANC 4+), skill birth attendant (SBA), and postnatal care (PNC) within 48 hours of delivery. It is one of the essential strategies for reducing maternal and newborn mortality. This study aimed to assess the factors associated with the completion of a continuum of maternal healthcare services among mothers who gave birth in the past five years. Methods A community-based cross-sectional study was conducted from May 01 to June 29, 2019, among 565 randomly selected mothers who gave birth in five years before the study in primary healthcare project implementation districts of north Gondar zone, Amhara National Regional State, Ethiopia. Bivariable and multivariable logistic regression analysis were computed, and in the multivariable logistic regression analysis, adjusted odds ratio (AOR) with 95% confidence interval (CI) and a p value of less than 0.05 were used to identify the associated factors with completion of the continuum of maternal healthcare services. Results The study revealed that the overall completion of the continuum of maternal healthcare services was 21.60% (95% CI: 18.20, 24.90). Women who were able to read and write (AOR: 2.70, 95% CI: 1.22, 6.04), using car/motorcycle as a means of transportation to get the health facility (AOR: 5.59, 95% CI: 2.29, 9.50), travel time less than an hour to get the health facility (AOR: 4.98, 95% CI: 2.97, 8.38), being satisfied with the service delivery (AOR: 1.89, 95% CI: 1.15, 3.11), and getting health education on maternal healthcare services in the last 6 months (AOR: 2.77, 95% CI: 1.52, 5.05) were factors associated with the completion of the continuum of maternal healthcare services. Conclusions The completion of the continuum of maternal healthcare services was relatively low, indicating that women were not getting the likely health benefit from the present health services. Therefore, interventions should focus on increasing women's awareness, improving the availability of services at nearby health facilities, and improving service delivery by considering women's preferences and needs to increase their satisfaction are essential to increase the completion of maternal healthcare services.
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Khader YS, Bawadi H, Khasawneh W, Alyahya MS, Shattnawi K, Al-Sheyab NA, Al Obeisat S, Asad M, Khatatneh K, Alkhdour MM, Al-Hamdan Z, Batieha A. Sociocultural, political, and health system-related determinants of perinatal deaths in Jordan from the perspectives of health care providers: a qualitative study. J Matern Fetal Neonatal Med 2020; 35:2765-2774. [PMID: 32727234 DOI: 10.1080/14767058.2020.1800632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Perinatal mortality is a fundamental indicator of the quality of the healthcare provided to women during pregnancy and childbirth, as well as the healthcare provided to neonates in the first week of life. At the national level, determining the direct and indirect causes of these deaths is vital, as it will assist in tracking the quality of antenatal, natal and postnatal care and help to detect the areas for avoidance. This study aimed to identify the main determinants of perinatal deaths in Jordan from the perspectives of health care providers (HCPs). METHODS A descriptive qualitative approach using focus group discussion was used. Four focus groups were conducted in each of the four hospitals where the approached HCPs are employed. An average of 5 HCPs were interviewed in each focus group with a total of 80 HCPs participating in the 16 focus groups. Thematic analysis was carried out to analyze the data. RESULTS The HCPs provided a detailed description of the determinants of perinatal and neonatal death from their points of view. Four main themes with multiple subthemes emerged, namely maternal factors (ignorance, concealment of medical condition, and husbands' negligence), sociocultural factors (socioeconomic status, tribal and consanguineous marriage, and harmful cultural practices), political factors (early marriage driven by displacement and war consequences on maternal health), and health system-related factors (services management including capabilities and logistics, overcrowding of emergency rooms, discharge against medical advice, and unskilled general practitioners in private maternity clinics). CONCLUSIONS As perceived by HCPs, maternal factors, sociocultural factors, political factors, and health system-related factors are the main determinants of perinatal deaths in Jordan. Improvement in the quality of maternal and neonatal health care services, maternal health education, and maternity staff training are strongly recommended.
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Affiliation(s)
- Yousef S Khader
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Hala Bawadi
- Maternal and Child Health Nursing Department, The University of Jordan, Amman, Jordan
| | - Wasim Khasawneh
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad S Alyahya
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khulood Shattnawi
- Department of Maternal and Child Health Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Nihaya A Al-Sheyab
- Child and Maternal Health Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Salwa Al Obeisat
- Maternal-Child Health Nursing Department, Faculty of Nursing/WHO Collaborating Center, Jordan University of Science and Technology, Irbid, Jordan
| | - Majed Asad
- Non-Communicable Diseases, MOH, Amman, Jordan
| | - Khalaf Khatatneh
- Department of Computer Science, Al-Balqa Applied University, Salt, Jordan
| | | | - Zaid Al-Hamdan
- Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Anwar Batieha
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Akter S, Rich JL, Davies K, Inder KJ. Prevalence and factors associated with knowledge and access to delivery services at primary health care facilities amongst indigenous women in Khagrachhari district Bangladesh - A cross-sectional study. Midwifery 2020; 90:102798. [PMID: 32717661 DOI: 10.1016/j.midw.2020.102798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/06/2020] [Accepted: 07/17/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To estimate the prevalence of facility delivery knowledge and access during childbirth amongst Indigenous women in the Chittagong Hill Tracts, Bangladesh and to identify factors associated with facility delivery service utilisation. DESIGN A cross-sectional study design using a structured self-report survey. SETTING Two Upazilas (subdistricts) of Kharachhari hill district of the Chittagong Hill Tracts. PARTICIPANTS Indigenous women of reproductive age (15-49 years) within 36 months of delivery. MEASUREMENTS AND FINDINGS A modified national survey about accessing maternal health services, including delivery services was administered to all Indigenous women that met eligibility, guided by community leaders. Data collected included socio-demographic characteristics and reproductive history. Main outcome variables were the proportion of women having prior knowledge about and access to facility delivery services for childbirth in the three years prior to the survey. Secondary outcomes were sources of information about facility delivery services, decision making about delivery place, and factors associated with knowledge and attendance at facility delivery services. Factors associated with knowledge and attendance were estimated using logistic regression with results reported as adjusted odds ratios and 95% confidence intervals. With an 89% response rate, a total of 438 Indigenous women (220 Chakma, 100 Marma, 118 Tripura) participated in the survey, and 75% were aged 16-29 years. Relatives played a vital role as a source of information about delivery services (59%). Nearly three-quarters (73%) were aware of facility delivery services, however, prevalence of accessing delivery services was 33% (n = 143; 95% CI 0.28-0.37). Relatives were the key decision-makers for accessing facility delivery services (60%). Independent factors associated with knowledge about facility delivery were higher household income (AOR 5.3, 95%CI 2.2-13); having knowledge of nearest health care facilities (AOR 5.8, 95%CI 3.0-11); and attending antenatal care visits during last pregnancy (four or more AOR 3.1, 95% CI 1.3-7.2 and one to three visits AOR 2.7, 95% CI 1.5-5.0). Independent factors associated with accessing facility delivery services at childbirth were attending antenatal care visit; having access to media; higher level of education of partners; and residing at Khagrachhari Sadar compared to Matiranga subdistrict. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Indigenous women in Chittagong Hill Tracts, Bangladesh have sub-optimal knowledge of, and attendance at, facility delivery services for childbirth. Maternal health related interventions should target Indigenous women in order to educate and motivate them to access facility delivery services at childbirth. Rigorous research is needed to explore Indigenous cultural practices related to childbirth that might influence their access to facility delivery services.
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Affiliation(s)
- Shahinoor Akter
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia; Priority Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton, New South Wales, Australia; Department of Anthropology, Jagannath University, Dhaka, Bangladesh.
| | - Jane L Rich
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia; Priority Research Centre for Brain and Mental Health, Callaghan, New South Wales, Australia.
| | - Kate Davies
- School of Humanities and Social Science, Faculty of Education and Arts, University of Newcastle, Callaghan, New South Wales, Australia.
| | - Kerry J Inder
- Priority Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton, New South Wales, Australia; School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.
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Baghel J, Keepanasseril A, Pillai AA, Mondal N, Jeganathan Y, Kundra P. Prediction of adverse cardiac events in pregnant women with valvular rheumatic heart disease. Heart 2020; 106:1400-1406. [PMID: 32601124 DOI: 10.1136/heartjnl-2020-316648] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the incidence of adverse cardiac events in pregnant women with rheumatic valvular heart disease (RHD) and to derive a clinical risk scoring for predicting it. METHODS This is an observational study involving pregnant women with RHD, attending a tertiary centre in south India. Data regarding obstetric history, medical history, maternal complications and perinatal outcome till discharge were collected. Eight-hundred and twenty pregnancies among 681 women were included in the analysis. Primary outcome was composite adverse cardiac event defined as occurrence of one or more of complications such as death, cardiac arrest, heart failure, cerebrovascular accident from thromboembolism and new-onset arrhythmias. RESULTS Of the 681 women with RHD, 180 (26.3%) were diagnosed during pregnancy. Composite adverse cardiac outcome during pregnancy/post partum occurred in 122 (14.9%) pregnancies, with 12 of them succumbed to the disease. In multivariate analysis, prior adverse cardiac events (OR=8.35, 95% CI 3.54 to 19.71), cardiac medications at booking (OR=0.53, 95% CI 0.32 to 0.86), mitral stenosis (mild OR=2.48, 95% CI 1.08 to 5.69; moderate OR=2.23, 95% CI 1.19 to 4.18; severe OR=7.72,95% 4.05 to 12.89), valve replacement (OR=2.53, 95% CI 1.28 to 5.02) and pulmonary hypertension (OR=6.90, 3.81 to 12.46) were predictive of composite adverse cardiac events with a good discrimination (area under the curve=0.803) and acceptable calibration. A predictive score combining these factors is proposed for clinical utility. CONCLUSION Heart failure remains the most common adverse cardiac event during pregnancy or puerperium. Combining the lesion-specific characteristics and clinical information into a predictive score, which is simple and effective, could be used in routine clinical practice.
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Affiliation(s)
- Jyoti Baghel
- Obstetrics & Gynaecology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Anish Keepanasseril
- Obstetrics & Gynaecology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Ajith Ananthakrishna Pillai
- Cardiology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Nivedita Mondal
- Neonatology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Yavanasuriya Jeganathan
- Obstetrics & Gynaecology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Pankaj Kundra
- Anaesthesiology & Critical Care, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
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Akter S, Rich JL, Davies K, Inder KJ. Access to maternal healthcare services among Indigenous women in the Chittagong Hill Tracts, Bangladesh: A cross-sectional study. BMJ Open 2019; 9:e033224. [PMID: 31662407 PMCID: PMC6830644 DOI: 10.1136/bmjopen-2019-033224] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study aimed to estimate the prevalence of, and factors associated with, accessing maternal healthcare services (MHC) by Indigenous women in the Chittagong Hill Tracts (CHT), Bangladesh. DESIGN This was a cross-sectional survey among Indigenous women of reproductive age. SETTING Two upazillas (subdistricts) of Khagrachhari hill district of the CHT. PARTICIPANTS Indigenous women (15-49 years) within 36 months of delivery were surveyed about accessing MHC services (antenatal care, delivery and postnatal care) for their last pregnancy and delivery. PRIMARY OUTCOME MEASURES The primary outcome for this analysis is the prevalence of accessing any MHC service and secondary outcome is factors associated with access to MHC services for Indigenous women during their last pregnancy and childbirth. RESULTS Of 438 Indigenous women (220 Chakma, 100 Marma, 118 Tripura) who participated, 75% were aged 16-30 years. With an 89% response rate, a total of 258 (59%) women reported accessing at least one MHC service (Chakma 51.6%, Marma 28%, Tripura 20.5%; p=<0.001). Independent factors associated with accessing MHC after adjusting for clustering were attending secondary school and above (OR 2.4; 95% CI 1.2 to 4.9); knowledge about nearest health facilities (OR 3.8, 95% CI 1.8 to 7.8) and knowledge of pregnancy-related complications (OR 3.0, 95% CI 1.5 to 5.8). CONCLUSION Findings suggest that the prevalence of accessing MHC services is lower among Indigenous women in the CHT compared with national average. MHC access may be improved through better education and awareness raising of local services.
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Affiliation(s)
- Shahinoor Akter
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Priority Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Department of Anthropology, Jagannath University, Dhaka, Bangladesh
| | - Jane Louise Rich
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Centre for Resources Health and Safety, Newcastle Institute of Energy and Resources, Shortland, New South Wales, Australia
| | - Kate Davies
- School of Humanities and Social Science, University of Newcastle, Newcastle, New South Wales, Australia
| | - Kerry Jill Inder
- Priority Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
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Brizuela V, Leslie HH, Sharma J, Langer A, Tunçalp Ö. Measuring quality of care for all women and newborns: how do we know if we are doing it right? A review of facility assessment tools. LANCET GLOBAL HEALTH 2019; 7:e624-e632. [DOI: 10.1016/s2214-109x(19)30033-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 12/10/2018] [Accepted: 01/17/2019] [Indexed: 12/27/2022]
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