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Fekadu H, Mekonnen W, Adugna A, Kloos H, Hailemariam D. Barriers to equitable healthcare services for under-five children in Ethiopia: a qualitative exploratory study. BMC Health Serv Res 2024; 24:613. [PMID: 38730298 PMCID: PMC11084004 DOI: 10.1186/s12913-024-11074-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 05/03/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Disparities in child healthcare service utilization are unacceptably high in Ethiopia. Nevertheless, little is known about underlying barriers to accessing child health services, especially among low socioeconomic subgroups and in remote areas. This study aims to identify barriers to equity in the use of child healthcare services in Ethiopia. METHODS Data were obtained from 20 key- informant interviews (KII) and 6 focus group discussions (FGD) with mothers and care givers. This study was conducted in Oromia Region, Arsi Zone, Zuway Dugda District from June 1-30, 2023. The study participants for this research were selected purposively. The information was collected based on the principle of saturation after sixteen consecutives interview were conducted. Both KII and FGD were audio-recorded and complementary notes were taken to record observations about the participants' comments and their interactions. Each interview and FGD data were transcribed word-for-word in the local Afaan Oromo and Amaharic languages and then translated to English language. Finally, the data were analyzed thematically using NVivo 14 software and narrated in the linked pattern of child health service utilization. RESULTS This study identified six major themes which emerged as barriers to healthcare utilization equity for caregivers and their -under-five children. Barriers related to equity in low level of awareness regarding need, low socioeconomic status, geographical inaccessibility, barriers related to deficient healthcare system, community perception and cultural restrictions, and barriers of equity related to political instability and conflict. The most commonly recognized barriers of equity at the community level were political instability, conflict, and a tremendous distance to a health facility. Transportation challenges, poor functional services, closure of the health facility in working hours, and lack of proper planning to address the marginalized populations were identified barriers of equity at organizational or policy level. CONCLUSION This study showed that inequity in child healthcare utilization is an important challenge confronting Ethiopia. To achieve equity, policy makers and planners need to change health policy and structure to be pro-poor. It is also necessary to improve the healthcare system to increase service utilization and access for impoverished women, individuals with lower levels of education, and residents of isolated rural areas. Furthermore, context specific information pertaining to cultural barriers and political ecology are required.
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Affiliation(s)
- Hailu Fekadu
- Department of Public Health, Arsi University College of Health Science, Assela, Ethiopia.
| | - Wubegzier Mekonnen
- School of Public Health, Addis Ababa University College of Health Science, Addis Ababa, Ethiopia
| | - Aynalem Adugna
- Department of Geography, Planning and Environmental Sonoma State University, Sonoma, San Francisco, USA
| | - Helmut Kloos
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Damen Hailemariam
- School of Public Health, Addis Ababa University College of Health Science, Addis Ababa, Ethiopia
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Wulandari RD, Laksono AD, Rohmah N, Matahari R, Antonio CA. Factors related to intrapartum/delivery care in Southeast Asia: A cross-sectional study in the Philippines and Indonesia. Heliyon 2024; 10:e27718. [PMID: 38500999 PMCID: PMC10945253 DOI: 10.1016/j.heliyon.2024.e27718] [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: 03/07/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 03/20/2024] Open
Abstract
Background Policy encouraging healthcare intrapartum/delivery care is critical to accelerating the decline in maternal mortality. The study analyzes intrapartum/delivery care factors in Indonesia and the Philippines. Methods The investigation included 15,346 Indonesian and 7992 Filipino women (ages 15 to 49 who delivered during the previous five years). Aside from the location of intrapartum/delivery care as a dependent variable, additional factors investigated included domicile, marital status, age, occupation, education, parity, wealth, and ANC-the conclusion of the study utilizing binary logistic regression. Results Women in both countries predominantly do healthcare intrapartum/delivery care. Both countries' urban women are more likely to receive intrapartum/delivery care than rural women. The higher the amount of schooling, the greater the likelihood of receiving intrapartum/delivery care. The lower the parity, the higher the chance to do healthcare intrapartum/delivery care. The higher the wealth position, the greater the likelihood of receiving intrapartum/delivery care. Furthermore, women in both nations who had four or more antenatal visits were more likely to receive intrapartum/delivery care. Conclusion The study concluded five factors related to healthcare intrapartum/delivery care in the Philippines: residence, education, parity, wealth, and ANC. Meanwhile, there are six factors related to healthcare intrapartum/delivery care in Indonesia: place, age, education, parity, wealth, and ANC.
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Affiliation(s)
- Ratna Dwi Wulandari
- Universitas Airlangga, Surabaya, Indonesia
- The Airlangga Centre for Health Policy (ACeHAP) Research Group, Surabaya, Indonesia
| | - Agung Dwi Laksono
- The Airlangga Centre for Health Policy (ACeHAP) Research Group, Surabaya, Indonesia
- National Research and Innovation Agency Republic of Indonesia, Jakarta, Indonesia
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Ipa M, Laksono AD, Aggraeni YM, Rohmah N. Factors Associated with the Place of Delivery among Urban Poor Societies in Indonesia. Indian J Community Med 2023; 48:888-893. [PMID: 38249692 PMCID: PMC10795872 DOI: 10.4103/ijcm.ijcm_798_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 09/27/2023] [Indexed: 01/23/2024] Open
Abstract
Background Pregnant women in urban poor societies are vulnerable groups. Due to low financial capacity, there are obstacles to accessing delivery in an institution for poor women in urban areas. The study analyses factors associated with the delivery place among pregnant women in urban poor society in Indonesia. Materials and Methods The study analyzed secondary data from the 2017 Indonesian Demographic and Health Survey (IDHS). A total of 1,562 samples were childbearing-age women (15-49 years) who gave birth in an urban poor society in Indonesia in the last 5 years. The study examined some variables, such as delivery place, age, education, employment, marital status, parity, insurance, knowledge of pregnancy danger, antenatal care (ANC), the autonomy of health, and family finance autonomy. The study employed binary logistic regression in the final stage. Results The results show that age is associated with the place of delivery. The higher the education, the higher the possibility for delivery in an institution. Being employed and having partners are protective factors for women in institution delivery. The likelihood of giving birth in a medical facility decreases as more children are born alive. In addition, having health insurance, thorough ANC visits, knowledge of pregnancy danger symptoms, and health autonomy are protective factors for pregnant women having deliveries in medical facilities. On the contrary, pregnant women who rely solely on family financing have a higher chance of delivering in a medical facility. Conclusion The study concluded that 10 variables were associated with pregnant women's delivery in Indonesia's urban poor society: age, education, employment, marital, parity, insurance, pregnancy danger knowledge, ANC, health autonomy, and family finance autonomy.
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Affiliation(s)
- Mara Ipa
- Research Centre for Public Health and Nutrition, Health Organization, The National Research and Innovation Agency, Indonesia
| | - Agung D. Laksono
- Research Centre for Public Health and Nutrition, Health Organization, The National Research and Innovation Agency, Indonesia
| | - Yusnita M. Aggraeni
- Research Centre for Public Health and Nutrition, Health Organization, The National Research and Innovation Agency, Indonesia
| | - Nikmatur Rohmah
- Faculty of Health Science, Universitas Muhammadiyah Jember, Indonesia
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Egbon OA, Bogoni MA, Babalola BT, Louzada F. Under age five children survival times in Nigeria: a Bayesian spatial modeling approach. BMC Public Health 2022; 22:2207. [PMID: 36443732 PMCID: PMC9706907 DOI: 10.1186/s12889-022-14660-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/17/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Nigeria is among the top five countries in the world with the highest under-five mortality rates. In addition to the general leading causes of under-five mortality, studies have shown that disparity in sociocultural values and practices across ethnic groups in Nigeria influence child survival, thus there is a need for scientific validation. This study quantified the survival probabilities and the impact of socioeconomic and demographic factors, proximate and biological determinants, and environmental factors on the risk of under-five mortality in Nigeria. METHODS The Kaplan-Meier survival curve, Nelson Aalen hazard curve, and components survival probabilities were estimated. The Exponential, Gamma, Log-normal, Weibull, and Cox hazard models in a Bayesian mixed effect hierarchical hazard modeling framework with spatial components were considered, and the Deviance and Watanabe Akaike information criteria were used to select the best model for inference. A [Formula: see text] level of significance was assumed throughout this work. The 2018 Nigeria Demographic and Health Survey dataset was used, and the outcome variable was the time between birth and death or birth and the date of interview for children who were alive on the day of the interview. RESULTS Findings show that the probability of a child dying within the first two months is 0.04, and the probability of a boy child dying before attaining age five is 0.106, while a girl child is 0.094 probability. Gender, maternal education, household wealth status, source of water and toilet facility, residence, mass media, frequency of antenatal and postnatal visits, marital status, place of delivery, multiple births, who decide healthcare use, use of bednet are significant risk factors of child mortality in Nigeria. The mortality risk is high among the maternal age group below 24 and above 44years, and birth weight below 2.5Kg and above 4.5Kg. The under-five mortality risk is severe in Kebbi, Kaduna, Jigawa, Adamawa, Gombe, Kano, Kogi, Nasarawa, Plateau, and Sokoto states in Nigeria. CONCLUSION This study accentuates the need for special attention for the first two months after childbirth as it is the age group with the highest expected mortality. A practicable way to minimize death in the early life of children is to improve maternal healthcare service, promote maternal education, encourage delivery in healthcare facilities, positive parental attitude to support multiple births, poverty alleviation programs for the less privileged, and a prioritized intervention to Northern Nigeria.
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Affiliation(s)
- Osafu Augustine Egbon
- Institute of Mathematical and Computer Sciences, University of São Paulo, São Carlos, Brazil
- Department of Statistics, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Mariella Ananias Bogoni
- Institute of Mathematical and Computer Sciences, University of São Paulo, São Carlos, Brazil
- Department of Statistics, Universidade Federal de São Carlos, São Carlos, Brazil
| | | | - Francisco Louzada
- Institute of Mathematical and Computer Sciences, University of São Paulo, São Carlos, Brazil
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Wuneh AD, Bezabih AM, Persson LÅ, Okwaraji YB, Medhanyie AA. "If I Was Educated, I Would Call the Ambulance and Give Birth at the Health Facility"-A Qualitative Exploratory Study of Inequities in the Utilization of Maternal, Newborn, and Child Health Services in Northern Ethiopia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11633. [PMID: 36141904 PMCID: PMC9517196 DOI: 10.3390/ijerph191811633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 08/24/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
In earlier studies, we have shown that the utilization of maternal health services in rural Ethiopia was distributed in a pro-rich fashion, while the coverage of child immunization was equitably distributed. Hence, this study aimed to explore mothers' and primary healthcare workers' perceptions of inequities in maternal, newborn, and child health services in rural Ethiopia, along with the factors that could influence such differentials. A qualitative study was conducted from November to December 2019 in two rural districts in Tigray, Ethiopia. Twenty-two in-depth interviews and three focus group discussions were carried out with mothers who had given birth during the last year before the survey. We also interviewed women's development group leaders, health extension workers, and health workers. The final sample was determined based on the principle of saturation. The interviews and focus group discussions were audiotaped, transcribed, translated, coded, and analyzed using thematic analysis. Two major themes emerged during the analysis that characterized the distribution of the service utilization and perceived causes of inequity. These were: (1) perceptions of the inequity in the use of maternal and child health services, and (2) perceived causes of inequity in maternal and child health service utilization. The mothers perceived antenatal care, facility-based delivery, and care-seeking for sick children to be inequitably distributed, while immunization was recognized as an equitable service. The inequity in the maternal and child health services was linked to poverty, lack of education, lack of access, and poor-quality services. The poor, the uneducated, and women who were distant from health facilities had a low utilization rate of services. The weak implementation of community-based equity-oriented policies, such as community-based health insurance, was perceived to result in health inequities. Mothers and primary healthcare providers in rural Ethiopia experienced weaknesses in delivering equitable services. The narratives could inform efforts to provide universal health coverage for mothers, newborns, and children by improving access and empowering women through poverty alleviation and education.
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Affiliation(s)
- Alem Desta Wuneh
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle P.O. Box 1871, Ethiopia
| | - Afework Mulugeta Bezabih
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle P.O. Box 1871, Ethiopia
| | - Lars Åke Persson
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Yemisrach Behailu Okwaraji
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Araya Abrha Medhanyie
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle P.O. Box 1871, Ethiopia
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Boniphace M, Matovelo D, Laisser R, Yohani V, Swai H, Subi L, Masatu Z, Tinka S, Mercader HFG, Brenner JL, Mitchell JL. The fear of social stigma experienced by men: a barrier to male involvement in antenatal care in Misungwi District, rural Tanzania. BMC Pregnancy Childbirth 2022; 22:44. [PMID: 35039002 PMCID: PMC8764782 DOI: 10.1186/s12884-022-04383-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 12/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Evidence has shown that male involvement is associated with improved maternal health outcomes. In rural Tanzania, men are the main decision makers and may determine women’s access to health services and ultimately their health outcomes. Despite efforts geared towards enhancing male participation in maternal health care, their involvement in antenatal care (ANC) remains low. One barrier that impacts men’s participation is the fear and experience of social stigma. This study, builds on previous findings about men’s perspectives in attending antenatal care appointments in Misungwi district in Tanzania, examining more closely the fear of social stigma amongst men attending ANC together with their partners. Methods Twelve individual interviews and five focus group discussions were conducted using semi-structured questionnaires with fathers and expectant fathers. In-depth interviews were conducted with health providers, volunteer community health workers and village leaders. Interviews were audiotaped, and transcripts were transcribed and translated to English. Transcripts were organized in NVivo V.12 then analyzed using thematic approach. Results Three main themes were found to create fear of social stigma for men: 1. Fear of HIV testing; 2. Traditional Gender Norms and 3. Insecurity about family social and economic status. Conclusion Respondent’s experiences reveal that fear of social stigma is a major barrier to attend ANC services with their partners. Attention must be given to the complex sociocultural norms and social context that underly this issue at the community level. Strategies to address fear of social stigma require an understanding of the real reasons some men do not attend ANC and require community engagement of community health workers (CHWs), government officials and other stakeholders who understand the local context.
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Affiliation(s)
- Maendeleo Boniphace
- Catholic University of Health and Allied Sciences (CUHAS), P. O. Box 1364, Mwanza, Tanzania
| | - Dismas Matovelo
- Catholic University of Health and Allied Sciences (CUHAS), P. O. Box 1364, Mwanza, Tanzania.
| | - Rose Laisser
- Catholic University of Health and Allied Sciences (CUHAS), P. O. Box 1364, Mwanza, Tanzania
| | - Victoria Yohani
- Catholic University of Health and Allied Sciences (CUHAS), P. O. Box 1364, Mwanza, Tanzania
| | - Hadija Swai
- Bugando Medical Centre (BMC), P. O. Box 1464, Mwanza, Tanzania
| | - Leonard Subi
- Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC), Mwanza, Tanzania
| | - Zabroni Masatu
- Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC), Mwanza, Tanzania
| | - Sylvia Tinka
- Catholic University of Health and Allied Sciences (CUHAS), P. O. Box 1364, Mwanza, Tanzania
| | - Hannah Faye G Mercader
- Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC), Mwanza, Tanzania
| | - Jennifer L Brenner
- Cumming School of Medicine, University of Calgary in Canada, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Jennifer L Mitchell
- Cumming School of Medicine, University of Calgary in Canada, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
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Kassim M, Ndumbaro F. An assessment of health information literacy among women in rural Lake Zone, Tanzania. IFLA JOURNAL-INTERNATIONAL FEDERATION OF LIBRARY ASSOCIATIONS 2021. [DOI: 10.1177/03400352211048914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article presents the results from a descriptive cross-sectional survey that was conducted to assess the health information literacy skills of women of childbearing age in rural Lake Zone, Tanzania. A total of 349 women were involved in the study. The study found that most rural women in the study area have low levels of health information literacy. The aggregate scores of health information literacy indicate a mean of 42.86% with a normal distribution curve, and estimated close-to-zero skewness (0.172) and kurtosis (−0.297) measures. The causal relationships between health information literacy and women’s socio-demographic factors indicate a positive and statistically significant effect ( p < .01) of women’s level of education, income, ownership of means of communication and access to health facilities on their level of health information literacy. The women’s inadequate ability to access, read, understand, appraise and use health information is a barrier to their acquisition of relevant health information. Enhancing the health information literacy skills of these women is most likely to improve their health outcomes.
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Affiliation(s)
- Mohamed Kassim
- Information Studies Programme, University of Dar es Salaam, Tanzania
| | - Faraja Ndumbaro
- Information Studies Programme, University of Dar es Salaam, Tanzania
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