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Demissie DB, Molla G, Tiruneh Tiyare F, Badacho AS, Tadele A. Magnitude, disparity, and predictors of poor-quality antenatal care service: A systematic review and meta-analysis. SAGE Open Med 2024; 12:20503121241248275. [PMID: 38737837 PMCID: PMC11085007 DOI: 10.1177/20503121241248275] [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: 12/12/2023] [Accepted: 03/27/2024] [Indexed: 05/14/2024] Open
Abstract
Background Antenatal care is directed toward ensuring healthy pregnancy outcomes. Quality antenatal care increases the likelihood of receiving an effective intervention to maintain maternal, fetal, and neonatal well-being, while poor quality is linked to poor pregnancy outcomes. However, owing to the complex nature of quality, researchers have followed several approaches to systematically measure it. The evidence from these variable approaches appears inconsistence and poses challenges to programmers and policymakers. Hence, it is imperative to obtain a pooled estimate of the quality of antenatal care. Therefore, considering the scarcity of evidence on the quality of antenatal care, this study aimed to review, synthesize, and bring pooled estimates of accessible evidence. Objective This study aimed to estimate the pooled magnitude and predictors of quality of antenatal care services and compare regional disparity. Method We conducted a comprehensive systematic three-step approach search of published and unpublished sources from 2002 to 2022. The methodological quality of eligible studies was checked using Joanna Briggs Institute critical appraisal tool for cross-sectional studies. Meta-analysis was carried out using STATA version 16. Statistical heterogeneity was assessed using Cochran's Q test. In the presence of moderate heterogeneity (I2 more than 50%), sensitivity and subgroup analyses were conducted and presented in a forest plot. Effect size was reported using standardized mean difference and its 95% confidence interval. Funnel plots and Egger's regression test were used to measure publication bias at the 5% significance level. A trim-and-fill analysis was conducted to adjust for publication bias. Pooled estimates were computed using random-effects models and weighted using the inverse variance method in the presence of high heterogeneity among studies. A 95% CI and 5% significance level were considered to declare significance variables. Results The global pooled poor-quality antenatal care was 64.28% (95% CI: 59.58%-68.98%) (I2 = 99.97%, p = 0.001). The identified pooled predictors of good-quality antenatal care service were: number of antenatal care visits (fourth and above antenatal care visit) (Adjusted odds ratio (AOR) = 2.6, 95% CI: 1.37-3.84), family wealth index (AOR = 2.72, 95% CI: 1.89-3.55), maternal education attainment (AOR = 3.03, 95% CI: 2.24-3.82), residence (urban dwellers) (AOR = 4.06, 95% CI: 0.95-7.17), and confidentiality antenatal care (AOR = 2.23, 95% CI: -0.36 to -4.82). Conclusions The study found regional and country-level disparities in the quality of antenatal care services for pregnant women, where poor-quality antenatal care services were provided for more than two-thirds to three-fourths of antenatal care attendants. Therefore, policymakers and health planners should put a great deal of emphasis on addressing the quality of antenatal care services.
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Affiliation(s)
- Dereje Bayissa Demissie
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Gebeyaw Molla
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Firew Tiruneh Tiyare
- Faculty of Public Health, Department of Epidemiology, Institute of Health, Jimma University, Jimma, Ethiopia
| | | | - Ashenif Tadele
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Alemu EM, Kaso AW, Obsie GW, Fessaha HZ, Agero G. Maternal satisfaction with delivery service and associated factors among women who gave birth at public hospitals in Guji Zone, Southern Ethiopia. BMC Womens Health 2024; 24:227. [PMID: 38589846 PMCID: PMC11000373 DOI: 10.1186/s12905-024-03069-0] [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: 05/11/2023] [Accepted: 04/02/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Maternal satisfaction during delivery services is considered an important indicator of the quality of healthcare in a hospital setting and determines the uptake of services during subsequent pregnancies. However, there is limited information on the magnitude of women's satisfaction during delivery services in the study area. Thus, this study aimed to assess factors associated with maternal satisfaction with delivery services among women who gave birth at public hospitals in Guji Zone, Southern Ethiopia. METHOD A facility-based cross-sectional study was conducted at public hospitals in Guji Zone from December 1, 2020, to January 30, 2021. Two hundred forty-nine women who gave birth at public hospitals were recruited by a systematic random sampling technique. The collected data were entered into the Epi Info 7 software and then exported to SPSS Version 26 for analysis. A logistic regression model was employed to identify the association between independent variables and maternal satisfaction during delivery services. A P-value less than 0.05 and an Adjusted Odds Ratio with 95% CI was computed to determine the strength of the association between these variables. RESULT In this study, 138(55.4%), 95% CI (49.1-61.7) women were satisfied with delivery. Mothers who delivered through cesarean section (AOR = 2.92, 95% CI: 1.34-6.33), privacy assured (AOR = 3.14, 95% CI: 1.76-5.59), shorter duration of labor (AOR = 2.82, 95% CI: 1.64-4.62), waiting time ≤ 30 min (AOR = 5.15,95% CI:1.99-13.32) and normal fetal outcome (AOR = 2.63, 95% CI:1.42-4.85) were associated with mothers satisfaction with delivery care services. CONCLUSION The overall magnitude of women's satisfaction with delivery services is low, which is below the national client satisfaction target of ≥ 85%. Factors such as mode of delivery, assured privacy, short duration of labor, waiting time ≤ 30 min, and good fetal outcome were significantly associated with women's satisfaction with delivery services. Therefore, healthcare providers should provide better management during intrapartum childbirth or emergency obstetric care to improve fetal outcomes during delivery services. In addition, health facility managers should avail infrastructure that helps to maintain the privacy of women who give birth in the facility.
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Affiliation(s)
- Endale Megersa Alemu
- Department of Family Health Services, Guji Zone Health Office, Negelle Borena, Ethiopia
| | - Abdene Weya Kaso
- Department of Public Health, College of Health Science, Arsi University, Asella, Ethiopia.
| | - Girma Worku Obsie
- Department of Public Health, College of Health Science, Arsi University, Asella, Ethiopia
| | - Hiwot Zelalem Fessaha
- Department of Public Health, College of Health Science, Arsi University, Asella, Ethiopia
| | - Gebi Agero
- Department of Public Health, College of Health Science, Arsi University, Asella, Ethiopia
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Tasneem S, Ozdal MA. Pregnant Women’s Perceptions of the Quality of Antenatal Care in a Public Hospital in Punjab, Pakistan during COVID-19: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:healthcare11070996. [PMID: 37046923 PMCID: PMC10094328 DOI: 10.3390/healthcare11070996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/15/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Despite government efforts, many rural Pakistani women forgo regular antenatal visits, are unprepared for birth, and deliver at home or in private facilities, because they are dissatisfied with public health services. This study examined pregnant women’s perceptions of public health hospital prenatal care to suggest areas for improvement. Using simple random sampling, 200 pregnant women visiting a secondary care public health facility in Sargodha District, Pakistan, were enrolled in a cross-sectional study. The quality of prenatal care was assessed using a structured and validated questionnaire. Descriptive analysis and multivariate linear regression stepwise models were used. Of participants, 52% consider the services to be of poor quality. Education, income, number of living children, and long waiting time influenced the perceived prenatal care quality in the study population. Stakeholders rated existing services as suboptimal, especially in terms of staff availability and time spent, which reduces service use. Facility managers and policymakers should work to improve the quality of services to satisfy patients, encourage them to use antenatal care, and improve the health of both mother and child, especially in rural areas.
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Affiliation(s)
- Saima Tasneem
- Department of Health Management, Institute of Graduate Studies and Research, European University of Lefke, TRNC-10 Mersin, Lefke 99770, Northern Cyprus, Turkey
| | - Macide Artac Ozdal
- Department of Health Management, Faculty of Health Sciences, European University of Lefke, TRNC-10 Mersin, Lefke 99770, Northern Cyprus, Turkey
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Anwar J, Torvaldsen S, Morrell S, Taylor R. Maternal Mortality in a Rural District of Pakistan and Contributing Factors. Matern Child Health J 2023; 27:902-915. [PMID: 36609798 DOI: 10.1007/s10995-022-03570-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Pakistan is among the ten countries that account for 60% of global maternal mortality. Lack of accurate data on maternal mortality and a complex interrelation of access and quality of healthcare services, healthcare delivery system, and socio-economic and demographic factors contribute significantly to inadequate progress in reducing maternal mortality. MATERIAL AND METHODS A population-based prospective cohort study was conducted in a rural district of Pakistan using data obtained from an enhanced surveillance system. A total of 7572 pregnancies and their outcomes were recorded by 273 Lady Health Workers and 73 Community Health Workers over 2016-2017. Logistic regression was used to calculate the unadjusted and adjusted odds ratios (OR) for maternal mortality for each risk factor. Population Attributable Fraction (PAF) was derived from the ORs and risk factor prevalence. RESULTS The study recorded 18 maternal deaths. The maternal mortality rate was estimated at 238/100,000 pregnancies (95% CI 141-376), and the maternal mortality ratio was 247/100,000 live births (95% CI 147-391). Half of the maternal deaths (9) were from obstetric hemorrhage, and 28% (5) from puerperal sepsis. Postpartum hemorrhage was associated with a 17-fold higher risk of maternal mortality (PAF = 40%) and puerperal sepsis with a 12-fold higher mortality risk (PAF = 29%) compared to women without these conditions. Women delivered by unskilled birth attendants had a three-fold (PAF = 21%), and women having prolonged labour had a fourfold risk of maternal mortality compared to those with these conditions. Women with leg swelling (47%) and pre-eclampsia (26%) are at seven times the risk of maternal mortality compared to those without these conditions. Mortality in women delivered by unskilled birth attendants was three times higher than with skilled attendants. CONCLUSION The study, among a few large-scale prospective cohort studies conducted at the community level in a rural district of Pakistan, provides a better understanding of the risk factors determining maternal mortality in Pakistan. Poverty emerged as a significant risk factor for maternal mortality in the study area and contributes to the underutilization of health facilities and skilled birth attendants. Incorporating poverty reduction strategies across all sectors, including health, is urgently required to address higher maternal mortality in Pakistan. A paradigm shift is required in Maternal and Child health related programs and interventions to include poverty estimation and measuring mortality through linking mortality surveillance with the Civil Registration and Vital Statistics system. Accelerated efforts to expand the coverage and completeness of mortality data with risk factors to address inequalities in access and utilization of health services.
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Affiliation(s)
- Jasim Anwar
- Department of Community Medicine, Women Medical and Dental College, Abbottabad, Pakistan.
- School of Population Health, UNSW Sydney, Sydney, Australia.
| | - Siranda Torvaldsen
- School of Population Health, UNSW Sydney, Sydney, Australia
- The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW, Australia
| | | | - Richard Taylor
- School of Population Health, UNSW Sydney, Sydney, Australia
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Abdulla F, Rahman A, Hossain MM. Prevalence and risk predictors of childhood stunting in Bangladesh. PLoS One 2023; 18:e0279901. [PMID: 36701381 PMCID: PMC9879476 DOI: 10.1371/journal.pone.0279901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 12/16/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The child nutritional status of a country is a potential indicator of socioeconomic development. Child malnutrition is still the leading cause of severe health and welfare problems across Bangladesh. The most prevalent form of child malnutrition, stunting, is a serious public health issue in many low and middle-income countries. This study aimed to investigate the heterogeneous effect of some child, maternal, household, and health-related predictors, along with the quantiles of the conditional distribution of Z-score for height-for-age (HAZ) of under five children in Bangladesh. METHODS AND MATERIALS In this study, a sample of 8,321 children under five years of age was studied from BDHS-2017-18. The chi-square test was mainly used to identify the significant predictors of the HAZ score and sequential quantile regression was used to estimate the heterogeneous effect of the significant predictors at different quantiles of the conditional HAZ distribution. RESULTS The findings revealed that female children were significantly shorter than their male counterparts except at the 75th quantile. It was also discovered that children aged 7-47 months were disadvantaged, but children aged 48-59 months were advantaged in terms of height over children aged 6 months or younger. Moreover, children with a higher birth order had significantly lower HAZ scores than 1st birth order children. In addition, home delivery, the duration of breastfeeding, and the BCG vaccine and vitamin A received status were found to have varied significant negative associations with the HAZ score. As well, seven or fewer antenatal care visits was negatively associated with the HAZ score, but more than seven antenatal care visits was positively associated with the HAZ score. Additionally, children who lived in urban areas and whose mothers were over 18 years and either normal weight or overweight had a significant height advantage. Furthermore, parental secondary or higher education had a significant positive but varied effect across the conditional HAZ distribution, except for the mother's education, at the 50th quantile. Children from wealthier families were also around 0.30 standard deviations (SD) taller than those from the poorest families. Religion also had a significant relationship with the conditional HAZ distribution in favor of non-Muslim children. CONCLUSIONS To enhance children's nutritional levels, intervention measures should be designed considering the estimated heterogeneous effect of the risk factors. This would accelerate the progress towards achieving the targets of Sustainable Development Goals (SDGs) related to child and maternal health in Bangladesh by 2030.
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Affiliation(s)
- Faruq Abdulla
- Department of Applied Health and Nutrition, RTM Al-Kabir Technical University, Sylhet, Bangladesh
| | - Azizur Rahman
- School of Computing, Mathematics and Engineering, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Md. Moyazzem Hossain
- Department of Statistics, Jahangirnagar University, Savar, Dhaka, Bangladesh
- School of Mathematics, Statistics and Physics, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
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Yoseph A, Teklesilasie W, Guillen-Grima F, Astatkie A. Individual- and community-level determinants of maternal health service utilization in southern Ethiopia: A multilevel analysis. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231218195. [PMID: 38126304 DOI: 10.1177/17455057231218195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Maternal health service utilization decreases maternal morbidity and mortality. However, the existing evidence is inadequate to design effective intervention strategies in Ethiopia. OBJECTIVES This study aimed to examine the utilization of maternal health service and identify its determinants among women of reproductive age in southern Ethiopia. DESIGN A community-based cross-sectional study was conducted from October 21 to November 11, 2022 on a sample of 1140 women selected randomly from the Northern Zone of the Sidama region. METHODS Data were collected using the Open Data Kit mobile application and exported to Stata version 15 for analysis. We used a multilevel mixed-effects modified Poisson regression with robust standard error to identify determinants of maternal health service utilization. RESULTS Utilization of antenatal care, health facility delivery, and postnatal care was 52.0% (95% confidence interval: 49.0%, 55.0%), 48.5% (95% confidence interval: 45.6%, 51.4%), and 26.0% (95% confidence interval: 23.0%, 29.0%), respectively. Antenatal care use was associated with receiving model family training (adjusted prevalence ratio: 1.19; 95% confidence interval: 1.06, 1.35), knowledge of antenatal care (adjusted prevalence ratio: 1.54; 95% confidence interval: 1.31, 1.81), perceived quality of antenatal care (adjusted prevalence ratio: 1.02; 95% confidence interval: 1.01, 1.03), and having birth preparedness plan (adjusted prevalence ratio: 1.13; 95% confidence interval: 1.02, 1.25). The identified determinants of health facility delivery use were middle wealth rank (adjusted prevalence ratio: 1.35; 95% confidence interval: 1.03, 1.77), perceived quality of health facility delivery (adjusted prevalence ratio: 1.02; 95% confidence interval: 1.01, 1.03), antenatal care (adjusted prevalence ratio: 1.76; 95% confidence interval: 1.36, 2.26), and high community-level women literacy (adjusted prevalence ratio: 1.55; 95% confidence interval: 1.10, 2.19). Postnatal care use was associated with facing health problems during postpartum period (adjusted prevalence ratio: 1.79; 95% confidence interval: 1.18, 2.72), urban residence (adjusted prevalence ratio: 3.52; 95% confidence interval: 2.15, 5.78), knowledge of postnatal care (adjusted prevalence ratio: 1.11; 95% confidence interval: 1.04, 1.19), and low community-level poverty (adjusted prevalence ratio: 0.43; 95% confidence interval: 0.25, 0.73). CONCLUSION Maternal health service use was low in the study area and was influenced by individual- and community-level determinants. Any intervention strategies must consider multi-sectorial collaboration to address determinants at different levels. The programs should focus on the provision of model family training, the needs of women who have a poor perception, and knowledge of maternal health service at the individual level.
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Affiliation(s)
- Amanuel Yoseph
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Wondwosen Teklesilasie
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | | | - Ayalew Astatkie
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Rahimi BA, Mohamadi E, Maku M, Hemat MD, Farooqi K, Mahboobi BA, Mudaser GM, Taylor WR. Challenges in antenatal care utilization in Kandahar, Afghanistan: A cross-sectional analytical study. PLoS One 2022; 17:e0277075. [PMID: 36409670 PMCID: PMC9678260 DOI: 10.1371/journal.pone.0277075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/20/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Quality antenatal care (ANC) is one of the four pillars of safe motherhood initiatives and improves the survival and health of mother and neonate. The main objective of this study was to assess the barriers in the utilization of ANC services in Kandahar, Afghanistan. METHODS This was a cross-sectional analytical study conducted over one year from December 2018-November 2019. Data were analyzed by descriptive statistics, Chi squared, and binary logistic regression. RESULTS A total of 1524 women were recruited in this study with mean age of 30.3 years. Of these women, 848 (55.6%) were rural dwellers, 1450/1510 (96.0%) were illiterate, 438/608 (72.0%) belonged to low-income families, 1112/1508 (73.7%) lived in joint families, 1420/1484 (95.7%) lived in a house of >10 inhabitants, while 388/1494 (26.0%) had attended had at least one ANC visit during their last pregnancy. On univariate analysis, the main barriers in the utilization of ANC services were living in rural areas, being illiterate, having lower socio-economic status, remoteness of the health facility from home, bad behavior of clinic personnel, and unplanned pregnancy. Only lower socio-economic status and bad behavior of clinic personnel were independent explanatory variables in the regression model. CONCLUSIONS Utilization of ANC services is inadequate in Kandahar province. Improving clinic staff professional behavior and status of women by expanding educational opportunities, and enhancing community awareness of the value of ANC are recommended.
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Affiliation(s)
- Bilal Ahmad Rahimi
- Faculty of Medicine, Department of Pediatrics, Kandahar University, Kandahar, Afghanistan
- Head of Research Unit, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
- * E-mail:
| | - Enayatullah Mohamadi
- Faculty of Medicine, Department of Public Health, Kandahar University, Kandahar, Afghanistan
| | - Muhibullah Maku
- Faculty of Medicine, Department of Public Health, Kandahar University, Kandahar, Afghanistan
| | - Mohammad Dawood Hemat
- Faculty of Medicine, Department of Public Health, Kandahar University, Kandahar, Afghanistan
| | - Khushhal Farooqi
- Faculty of Medicine, Department of Dermatology, Kandahar University, Kandahar, Afghanistan
| | - Bashir Ahmad Mahboobi
- Faculty of Medicine, Department of Pediatrics, Kandahar University, Kandahar, Afghanistan
| | | | - Walter R. Taylor
- Senior Clinical Research Fellow, Mahidol Oxford Tropical Medicine Clinical Research unit (MORU), Mahidol University, Bangkok, Thailand
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Nahar MT, Anik SMFI, Islam MA, Islam SMS. Individual and community-level factors associated with skilled birth attendants during delivery in Bangladesh: A multilevel analysis of demographic and health surveys. PLoS One 2022; 17:e0267660. [PMID: 35767568 PMCID: PMC9242462 DOI: 10.1371/journal.pone.0267660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 04/13/2022] [Indexed: 11/25/2022] Open
Abstract
Background Skilled birth attendants (SBAs) play a crucial role in reducing infant and maternal mortality. Although the ratio of skilled assistance at birth has increased in Bangladesh, factors associated with SBA use are unknown. The main goal of our study was to reveal the individual- and community-level factors associated with SBA use during childbirth in Bangladesh. We also showed the prevalence and trend of SBA use and related independent variables in Bangladesh over the past decade. Methods This study utilized the Bangladesh Health and Demographic Survey (BDHS) 2017–2018, a cross-sectional study. We used binary logistic regression to examine the extent of variation in SBA use attributable to the individual- and community-level variables. Results Overall, 53.35% of women received assistance from SBAs during childbirth. The average annual rate of increase (AARI) in the number of SBA-assisted births over the past 10 years was 8.88%. Respondents who gave birth at or above 19 years had 1.40 times (AOR = 1.40; 95% CI: 1.21–1.62) greater odds of having skilled delivery assistance than respondents aged 18 years old or less. Women and their husband’s education levels were significantly associated with using skilled assistance during delivery, with odds of 1.60 (AOR = 1.60; 95% CI: 1.45–2.01) and 1.41 (AOR = 1.41; 95% CI: 1.21–1.66), respectively compared to those with education up to primary level. Women from rich families and those receiving better antenatal care (ANC) visits were more likely to have professional delivery assistance. Community-level factors also showed significance towards having professional assistance while giving birth. Women from urban communities and those who utilized more than four ANC visits and had completed secondary or higher education showed a greater tendency to use an SBA during childbirth than their counterparts. Conclusion The use of SBAs during delivery was significantly associated with some individual- and community-level factors. To reduce maternal and child mortality, there is a need to focus on rural and uneducated people who are less likely to access these facilities. Special programs could increase awareness and help the poor community obtain the minimum facility in maternal care.
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Affiliation(s)
- Mst. Tanmin Nahar
- Statistics Discipline, Science Engineering & Technology School, Khulna University, Khulna, Bangladesh
| | - S. M. Farhad Ibn Anik
- Statistics Discipline, Science Engineering & Technology School, Khulna University, Khulna, Bangladesh
| | - Md. Akhtarul Islam
- Statistics Discipline, Science Engineering & Technology School, Khulna University, Khulna, Bangladesh
- * E-mail:
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Factors Associated with Underutilization of Maternity Health Care Cascade in Mozambique: Analysis of the 2015 National Health Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137861. [PMID: 35805519 PMCID: PMC9265725 DOI: 10.3390/ijerph19137861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023]
Abstract
Maternity health care services utilization determines maternal and neonate outcomes. Evidence about factors associated with composite non-utilization of four or more antenatal consultations and intrapartum health care services is needed in Mozambique. This study uses data from the 2015 nationwide Mozambique’s Malaria, Immunization and HIV Indicators Survey. At selected representative households, women (n = 2629) with child aged up to 3 years answered a standardized structured questionnaire. Adjusted binary logistic regression assessed associations between women-child pairs characteristics and non-utilization of maternity health care. Seventy five percent (95% confidence interval (CI) = 71.8–77.7%) of women missed a health care cascade step during their last pregnancy. Higher education (adjusted odds ratio (AOR) = 0.65; 95% CI = 0.46–0.91), lowest wealth (AOR = 2.1; 95% CI = 1.2–3.7), rural residency (AOR = 1.5; 95% CI = 1.1–2.2), living distant from health facility (AOR = 1.5; 95% CI = 1.1–1.9) and unknown HIV status (AOR = 1.9; 95% CI = 1.4–2.7) were factors associated with non-utilization of the maternity health care cascade. The study highlights that, by 2015, recommended maternity health care cascade utilization did not cover 7 out of 10 pregnant women in Mozambique. Unfavorable sociodemographic and economic factors increase the relative odds for women not being covered by the maternity health care cascade.
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Kumbeni MT, Apanga PA. Institutional delivery and associated factors among women in Ghana: findings from a 2017-2018 multiple indicator cluster survey. Int Health 2021; 13:520-526. [PMID: 33539526 PMCID: PMC8643427 DOI: 10.1093/inthealth/ihab002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/29/2020] [Accepted: 01/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background Institutional delivery is essential in reducing maternal morbidity and mortality. We investigated the prevalence of institutional delivery and associated factors among women in Ghana. Methods National representative data from the 2017–2018 Ghana Multiple Indicator Cluster Survey was used for the analysis. The study included 3466 women, ages 15–49 y, who had a live birth in the last 2 y. Descriptive statistics were used to assess the prevalence of institutional delivery while multivariate logistic regression was used to assess the relationship between our variables of interest and institutional delivery. Results The prevalence of institutional delivery among women in Ghana was 77.89% (95% confidence interval [CI] 75.29 to 80.50). High-income households (adjusted odds ratio [aOR] 2.13 [95% CI 1.36 to 3.35]), attending antenatal care at least four times (aOR 2.37 [95% CI 1.54 to 3.65]) and knowing one's human immunodeficiency virus status (aOR 1.41 [95% CI 1.08 to 1.84]) were associated with higher odds of institutional delivery. Living in rural areas (aOR 0.43 [95% CI 0.27 to 0.67]), multiparity (aOR 0.59 [95% CI 0.41 to 0.85]) and no health insurance (aOR 0.57 [95% CI 0.44 to 0.74]) were associated with lower odds of institutional delivery. Conclusions The government of Ghana may need to focus on increasing health insurance utilization and antenatal care attendance in order to increase the coverage of institutional delivery.
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Affiliation(s)
- Maxwell T Kumbeni
- Ghana Health Service, Nabdam District Health Directorate, Nangodi, Ghana
| | - Paschal A Apanga
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
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Arroyave L, Saad GE, Victora CG, Barros AJD. A new content-qualified antenatal care coverage indicator: Development and validation of a score using national health surveys in low- and middle-income countries. J Glob Health 2021; 11:04008. [PMID: 33692892 PMCID: PMC7916319 DOI: 10.7189/jogh.11.04008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Good quality antenatal care (ANC) helps reduce adverse maternal and newborn outcomes, especially in low and middle-income countries (LMICs). Most of the currently used ANC indicators only measure contact with services. We aimed to create and validate a new indicator measured as a score, considering both contact and content, that can be used for monitoring. Methods We used data from national surveys conducted in LMICs. Information on ANC was used to build an adequacy score (ANCq) that would be applicable to all women in need of ANC. Cronbach's alpha and factor analysis were used to assess the proposed indicator. We also used a convergent validation approach, exploring the association of our proposed indicator with neonatal mortality. Results The ANCq score was derived from seven variables related to contact with services and content of care ranging from zero to ten. Surveys from 63 countries with all variables were used. The validity assessment showed satisfactory results based on Cronbach's alpha (0.82) and factor analysis. The overall mean of ANCq was 6.7, ranging from 3.5 in Afghanistan to 9.3 in Cuba and the Dominican Republic. In most countries, the ANCq was inversely associated with neonatal mortality and the pooled for all surveys Odds Ratio was 0.90 (95% CI = 0.88-0.92). Conclusions ANCq allows the assessment of ANC in LMICs considering contact with services and content of care. It also presented good validity properties, being a useful tool for assessing ANC coverage and adequacy of care in monitoring and accountability exercises.
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Affiliation(s)
- Luisa Arroyave
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil.,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Ghada E Saad
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil.,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Aluisio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil.,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
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Exploring women's experience of healthcare use during pregnancy and childbirth to understand factors contributing to perinatal deaths in Pakistan: A qualitative study. PLoS One 2020; 15:e0232823. [PMID: 32379843 PMCID: PMC7205296 DOI: 10.1371/journal.pone.0232823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 04/22/2020] [Indexed: 11/19/2022] Open
Abstract
Understanding key healthcare system challenges experienced by women during pregnancy and birth is crucial to scale up available interventions and reduce perinatal mortality. A community perspective about preferences and experience of care during this period can be used to improve community-based programs to reduce perinatal mortality. Using a qualitative exploratory approach, we examined women's experience of perinatal loss, aiming to understand the main factors, as perceived and experienced by women, leading to perinatal loss. Qualitative in-depth Interviews were conducted with 25 mothers with a recent perinatal loss, three family members, six healthcare officials, and two focus group discussions with 17 lady health workers. Data were analysed using inductive and deductive coding, by thematic analysis. Our findings revealed three distinct but interrelated themes, which include: 1) poor access to care during pregnancy and birth, 2) unavailability of appropriate healthcare services, and 3) poor quality of care during pregnancy and birth. Women frequently delayed seeking formal care around birth because of delays by themselves, their family members, or the local traditional birth attendants who frequently induced births at women's homes without recognising the dangers to the mothers or their babies. Preference for private care was common, however they often could not bear the cost of care when they needed caesarean section or in-patient care for their sick newborns because these services were absent in public health facilities of the district. Referral to the regional tertiary care hospital was often not officially arranged leading to risky births in small and crowded private clinics. Women's views about negative staff attitudes and the lack of attention given to them in public health facilities highlighted a lack of quality and respectful antenatal care. Improvement in women's access to essential care during pregnancy and around birth, availability of emergency obstetric and newborn care, improving the quality of maternal and newborn care in both public and private health facilities at the district level might reduce perinatal mortality in Pakistan.
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Abebe E, Seid A, Gedefaw G, Haile ZT, Ice G. Association between antenatal care follow-up and institutional delivery service utilization: analysis of 2016 Ethiopia demographic and health survey. BMC Public Health 2019; 19:1472. [PMID: 31699062 PMCID: PMC6839186 DOI: 10.1186/s12889-019-7854-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, the magnitude of maternal mortality is the major public health problem. Nearly all (99%) of maternal deaths occur in low- and middle-income countries. Of which 66% occur in sub-Saharan Africa. Institutional delivery under the hygienic environment with the necessary skills and equipment promotes to identify and treat complications, infections, and the death of the mother and baby. In Ethiopia, the utilization of maternal health services is very low. For instance, 62% of women had antenatal care utilization during pregnancy while only 26% of women utilize institutions for delivery in 2016. Therefore, this study examined the association between antenatal care follow up and intestinal delivery among a nationally representative woman in Ethiopia. METHODS A cross-sectional study design was used to examine 7575 women from the 2016 Ethiopia Demographic and Health Survey. Both descriptive and inferential statistics were utilized. Variables in the bivariate logistic regression with p-value < 0.2 were entered into the multivariable logistic regression. Odds ratios and corresponding 95% confidence intervals (CI) were reported. In the multivariable analysis, variables with p-value < 0.05 were considered as statistically significant. RESULTS The prevalence of institutional delivery service utilization for last childbirth was 11.3%. In comparison with women with no antenatal care visits, the multivariable odds ratio (95% confidence interval) of institutional delivery among those who attend one to three and four or more antenatal care visit were 2.49 (1.66, 3.74) and 3.90 (2.60, 5.84), respectively. Other factors significantly associated with institutional delivery include urban residence 2.25 (1.44, 3.51), complete primary education 3.22 (2.09, 4.98), complete secondary or higher education 1.59 (1.16, 2.17), poorer household wealth index 2.57 (1.57, 4.20), middle household wealth index 1.63 (1.05, 2.52), and richer household wealth index 1.56(1.03, 2.58). CONCLUSION Antenatal care follow-up was significantly associated with institutional delivery service utilization. As the number of antenatal care visits increased the odds of facility delivery increased. Thus, improved access and utilization of antenatal care can be an effective strategy to increase institutional deliveries and optimal maternal and child health outcomes.
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Affiliation(s)
- Eskezaiw Abebe
- School of Midwifery, College of Health Sciences, Woldia University, Woldia, Ethiopia.
| | - Abdu Seid
- School of Midwifery, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Getnet Gedefaw
- School of Midwifery, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Zelalem T Haile
- Department of Social Medicine, Ohio University Heritage, College of Osteopathic Medicine, Dublin, OH, USA
| | - Gillian Ice
- Department of Social Medicine, Ohio University Heritage, College of Osteopathic Medicine, Athens, OH, USA
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Enablers and Barriers to the Utilization of Antenatal Care Services in India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173152. [PMID: 31470550 PMCID: PMC6747369 DOI: 10.3390/ijerph16173152] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 12/28/2022]
Abstract
Antenatal care (ANC) reduces adverse health outcomes for both mother and baby during pregnancy and childbirth. The present study investigated the enablers and barriers to ANC service use among Indian women. The study used data on 183,091 women from the 2015–2016 India Demographic and Health Survey. Multivariate multinomial logistic regression models (using generalised linear latent and mixed models (GLLAMM) with the mlogit link and binomial family) that adjusted for clustering and sampling weights were used to investigate the association between the study factors and frequency of ANC service use. More than half (51.7%, 95% confidence interval (95% CI): 51.1–52.2%) of Indian women had four or more ANC visits, 31.7% (95% CI: 31.3–32.2%) had between one and three ANC visits, and 16.6% (95% CI: 16.3–17.0%) had no ANC visit. Higher household wealth status and parental education, belonging to other tribes or castes, a woman’s autonomy to visit the health facility, residence in Southern India, and exposure to the media were enablers of the recommended ANC (≥4) visits. In contrast, lower household wealth, a lack of a woman’s autonomy, and residence in East and Central India were barriers to appropriate ANC service use. Our study suggests that barriers to the recommended ANC service use in India can be amended by socioeconomic and health policy interventions, including improvements in education and social services, as well as community health education on the importance of ANC.
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Impact of Socio-Economic Factors and Health Information Sources on Place of Birth in Sindh Province, Pakistan: A Secondary Analysis of Cross-Sectional Survey Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16060932. [PMID: 30875876 PMCID: PMC6466183 DOI: 10.3390/ijerph16060932] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 11/30/2022]
Abstract
Medical facility birth with skilled birth attendance is essential to reduce maternal mortality. The purpose of this study was to assess the demographic characteristics, socio-economic factors, and varied health information sources that may influence the uptake of birth services in Pakistan. We used pooled data from Maternal-Child Health Program Indicator Survey 2013 and 2014. Study population was 9719 women. Generalized linear model with log link and a Poisson distribution was used to identify factors associated with place of birth. 3403 (35%) women gave birth at home, and 6316 (65%) women gave birth at a medical facility. After controlling for all covariates, women’s age, number of children, education, wealth, and mother and child health information source (doctors and nurses/midwives) were associated with facility births. Women were significantly less likely to give birth at a medical facility if they received maternal-child health information from low-level health workers or relatives/friends. The findings suggest that interventions should target disadvantaged and vulnerable groups of women after considering rural-urban differences. Training non-health professionals may help improve facility birth. Further research is needed to examine the effect of individual information sources on facility birth, both in urban and rural areas in Pakistan.
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Individual and community level factors associated with health facility delivery: A cross sectional multilevel analysis in Bangladesh. PLoS One 2019; 14:e0211113. [PMID: 30759099 PMCID: PMC6373895 DOI: 10.1371/journal.pone.0211113] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 01/08/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Improving maternal health remains one of the targets of sustainable development goals. A maternal death can occur at any time during pregnancy, but delivery is by far the most dangerous time for both the woman and her baby. Delivery at a health facility can avoid most maternal deaths occurring from preventable obstetric complications. The influence of both individual and community factors is critical to the use of health facility delivery services. In this study, we aim to examine the role of individual and community factors associated with health facility-based delivery in Bangladesh. Methods This cross-sectional study used data from the Bangladesh Maternal Mortality Survey. The sample size constitutes of 28,032 women who had delivered within five years preceding the survey. We fitted logistic random effects regression models with the community as a random effect to assess the influence of individual and community level factors on use of health facility delivery services. Results Our study observed substantial amount of variation at the community level. About 28.6% of the total variance in health facility delivery could be attributed to the differences across the community. At community level, place of residence (AOR 1.48; 95% CI 1.35–1.64), concentration of poverty (AOR 1.15; 95% CI 1.03–1.28), concentration of use of antenatal care services (AOR 1.11, 95% CI 1.00–1.23), concentration of media exposure (AOR 1.20, 95% CI 1.07–1.34) and concentration of educated women (AOR 1.12, 95% CI 1.02–1.23) were found to be significantly associated with health facility delivery. At individual level, maternal age, educational status of the mother, religion, parity, delivery complications, individual exposure to media, individual access to antenatal care and household socioeconomic status showed strong association with health facility-based delivery. Conclusion Our results strongly suggest factors at both Individual, and community level influenced the use of health facility delivery services in Bangladesh. Thus, any future strategy to improve maternal health in Bangladesh must consider community contexts and undertake multi-sectorial approach to address barriers at different levels. At the individual level the programs should also focus on the need of the young mother, the multiparous the less educated and women in the poorest households.
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Sarker AR, Sultana M, Ali N, Akram R, Sheikh N, Mahumud RA, Morton A. Cost comparison and determinants of out‐of‐pocket payments on child delivery care in Bangladesh. Int J Health Plann Manage 2018; 33:e1232-e1249. [DOI: 10.1002/hpm.2615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/09/2018] [Accepted: 07/11/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Abdur Razzaque Sarker
- Health Economics and Financing ResearchInternational Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
- Department of Management ScienceUniversity of Strathclyde Glasgow UK
| | - Marufa Sultana
- Nutrition and Clinical Services DivisionInternational Centre for Diarrheal Disease Research, Bangladesh Dhaka Bangladesh
- School of Health and Social DevelopmentDeakin University Melbourne Victoria Australia
| | - Nausad Ali
- Health Economics and Financing ResearchInternational Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Raisul Akram
- Health Economics and Financing ResearchInternational Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Nurnabi Sheikh
- Health Economics and Financing ResearchInternational Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | | | - Alec Morton
- Department of Management ScienceUniversity of Strathclyde Glasgow UK
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Mahato PK, van Teijlingen E, Simkhada P, Sheppard ZA, Silwal RC. Factors related to choice of place of birth in a district in Nepal. SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 13:91-96. [PMID: 28844364 DOI: 10.1016/j.srhc.2017.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 05/13/2017] [Accepted: 07/05/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In Nepal, both percentage of women giving birth at health facility and proportion of birth assisted by skilled birth attendant is very low. The purpose of this research was to identify predictors for choice of place of birth: either at home, primary health care facility (including birthing centres) or at tertiary health care facilites (hospitals and clinics). METHODS A cross-sectional household survey was conducted in seven village development committee of a district lying in plain area of Nepal: Nawalparasi. A structured interview questionnaire was developed and administered face-to-face. Descriptive analysis along with chi-square test and multinomial logistic regression was used to identify the predictors of giving birth at a health care facility. RESULTS Women were significantly more likely to give birth at health care facilities compared to home if the distance was less than one hour, belonged to advantaged caste, had radio, television and motorbike/scooter, decision maker for place of birth was husband, reported their frequency of antenatal (ANC) visits at 4 or more and belonged to age group 15-19. CONCLUSION The analysis indicates that husbands of women giving birth influence the choice of place of birth. The findings highlight importance of having four or more ANC visits to the health institutions and that it should be located within one-hour walking distance. Inequity in utilisation of childbirth services at health institutions exists as showed by low utilisation of such services by disadvantaged caste.
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Affiliation(s)
- Preeti K Mahato
- Faculty of Health & Social Sciences, Bournemouth House, 19 Christchurch Road, Bournemouth University, Bournemouth BH1 3LH, UK.
| | - Edwin van Teijlingen
- Faculty of Health & Social Sciences, Bournemouth House, 19 Christchurch Road, Bournemouth University, Bournemouth BH1 3LH, UK.
| | - Padam Simkhada
- Public Health Institute, Henry Cotton Building, 15-21 Webster Street, Liverpool L3 2ET, UK.
| | - Zoe A Sheppard
- Faculty of Health and Social Sciences, Christchurch Road, Bournemouth University, Bournemouth BH1 3LT, UK.
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