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Tang MB, Kung PT, Chiu LT, Tsai WC. Comparison of the use of prenatal care services and the risk of preterm birth between pregnant women with disabilities and those without disabilities: A nationwide cohort study. Front Public Health 2023; 11:1090051. [PMID: 36778582 PMCID: PMC9911428 DOI: 10.3389/fpubh.2023.1090051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
Objective The difficulties faced by pregnant women with disabilities in accessing health care may make them less likely to receive prenatal care. The aims of this study were to compare the number of prenatal services and the risk of preterm birth between pregnant women with and without disabilities. Methods A total of 2999 pregnant women aged ≥20 years with birth records in 2011-2014 in Taiwan were enrolled. Data were obtained from the Registration File for Physical and Mental Disabilities and the National Health Insurance Research Database. A 1:4 matching between pregnant women with disabilities and those without disabilities was performed. The logistic regression analysis with generalized estimating equations was used to analyze. Results The median of prenatal care services used by pregnant women with disabilities was 9.00 (interquartile range, IQR: 2.00). Pregnant women with disabilities used fewer services than those without disabilities (median, 10.00; IQR: 1.00). The disabled group (8.44%) had a significantly higher proportion of preterm births than did the non-disabled group (5.40%). The disabled group was at a 1.30 times higher risk of preterm births than was the non-disabled group. Conclusions Pregnant women with disabilities used significantly fewer prenatal care services and had a significantly higher risk of preterm birth than pregnant women without disabilities.
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Affiliation(s)
- Meng-Bin Tang
- Department of Public Health, Graduate Institute of Public Health, China Medical University, Taichung, Taiwan,Department of Health Services Administration, China Medical University, Taichung, Taiwan,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Li-Ting Chiu
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan,*Correspondence: Wen-Chen Tsai ✉
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Lassi ZS, Middleton P, Bhutta ZA, Crowther C. Health care seeking for maternal and newborn illnesses in low- and middle-income countries: a systematic review of observational and qualitative studies. F1000Res 2019; 8:200. [PMID: 31069067 PMCID: PMC6480947 DOI: 10.12688/f1000research.17828.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2019] [Indexed: 12/03/2022] Open
Abstract
Background: In low- and middle-income countries, a large number of maternal and newborn deaths occur due to delays in health care seeking. These delays occur at three levels i.e. delay in making decision to seek care, delay in access to care, and delay in receiving care. Factors that cause delays are therefore need to be understand to prevent and avoid these delays to improve health and survival of mothers and babies. Methods: A systematic review of observational and qualitative studies to identify factors and barriers associated with delays in health care seeking. Results: A total of 159 observational and qualitative studies met the inclusion criteria. The review of observational and qualitative studies identified social, cultural and health services factors that contribute to delays in health care seeking, and influence decisions to seek care. Timely recognition of danger signs, availability of finances to arrange for transport and affordability of health care cost, and accessibility to a health facility were some of these factors. Conclusions: Effective dealing of factors that contribute to delays in health care seeking would lead to significant improvements in mortality, morbidity and care seeking outcomes, particularly in countries that share a major brunt of maternal and newborn morbidity and mortality. Registration: PROSPERO
CRD42012003236.
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Affiliation(s)
- Zohra S Lassi
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Philippa Middleton
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.,Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada.,Center of Excellence for Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Caroline Crowther
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.,Liggins Institute, The University of Auckland, Auckland, New Zealand
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Zong Z, Huang J, Sun X, Mao J, Shu X, Hearst N. Prenatal care among rural to urban migrant women in China. BMC Pregnancy Childbirth 2018; 18:301. [PMID: 30005631 PMCID: PMC6044009 DOI: 10.1186/s12884-018-1934-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 07/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a very large population of internal migrants in China, and the majority of migrant women are of childbearing age. Little is known about their utilization of prenatal care and factors that influence this. We examined this using data from a large national survey of migrants. METHODS 5372 married rural to urban migrant women aged 20-34 who were included in the 2014 National Dynamic Monitoring Survey on Migrants and who delivered a baby within the previous two years were studied. We examined demographic and migration experience predictors of prenatal care in the first trimester and of adequate prenatal visits. RESULTS 12.6% of migrant women reported no examination in the first trimester and 27.6% had less than 5 prenatal visits during their latest pregnancy. Multivariate analysis indicated that demographic predictors of delayed and inadequate care included lower educational level, lower income and not having childbearing insurance. Migrating before pregnancy, longer time since migration, having migrated a greater distance, and not returning to their home town for delivery were correlated with better prenatal care. CONCLUSIONS Many internal migrant women in China do not receive adequate prenatal care. While internal migration before pregnancy seems to promote adequate prenatal care, it also creates barriers to receiving care. Strategies to improve prenatal care utilization include expanding access to childbearing insurance and timely education for women before and after they migrate.
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Affiliation(s)
- Zhanhong Zong
- School of Public Administration, Hohai University, Nanjing, China
- School of Sociology and Population Sciences, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Jianyuan Huang
- School of Public Administration, Hohai University, Nanjing, China
| | - Xiaoming Sun
- School of Sociology and Population Sciences, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Jingshu Mao
- School of Sociology and Population Sciences, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Xingyu Shu
- School of Sociology and Population Sciences, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Norman Hearst
- Department of Family and Community Medicine, University of California, San Francisco, CA USA
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Guanais FC. The combined effects of the expansion of primary health care and conditional cash transfers on infant mortality in Brazil, 1998-2010. Am J Public Health 2015; 105 Suppl 4:S593-9, S585-92. [PMID: 26313048 PMCID: PMC4561609 DOI: 10.2105/ajph.2013.301452r] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES I examined the combined effects of access to primary care through the Family Health Program (FHP) and conditional cash transfers from the Bolsa Familia Program (BFP) on postneonatal infant mortality (PNIM) in Brazil. METHODS I employed longitudinal ecological analysis using panel data from 4583 Brazilian municipalities from 1998 to 2010, totaling 54 253 observations. I estimated fixed-effects ordinary least squares regressions models with PNIM rate as the dependent variable and FHP, BFP, and their interactions as the main independent variables of interest. RESULTS The association of higher FHP coverage with lower PNIM became stronger as BFP coverage increased. At the means of all other variables, when BFP coverage was 25%, predicted PNIM was 5.24 (95% confidence interval [CI] = 4.95, 5.53) for FHP coverage = 0% and 3.54 (95% CI = 2.77, 4.31) for FHP coverage = 100%. When BFP coverage was 60%, predicted PNIM was 4.65 (95% CI = 4.36, 4.94) when FHP coverage = 0% and 1.38 (95% CI = 0.88, 1.89) when FHP coverage = 100%. CONCLUSIONS The effect of the FHP depends on the expansion of the BFP. For impoverished, underserved populations, combining supply- and demand-side interventions may be necessary to improve health outcomes.
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Affiliation(s)
- Frederico C Guanais
- Frederico C. Guanais is with the Social Protection and Health Division, Inter-American Development Bank, Washington, DC
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5
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Guanais FC. Efectos combinados de la ampliación de la atención primaria de salud y de las transferencias condicionadas de dinero en efectivo sobre la mortalidad infantil en Brasil, 1998–2010. Am J Public Health 2015. [DOI: 10.2105/ajph.2013.301452s] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objetivos. Examiné los efectos combinados del acceso a la atención primaria mediante el Programa de Salud Familiar (PSF) y las transferencias condicionadas de dinero en efectivo del Programa Bolsa Familia (PBF) sobre la mortalidad infantil posneonatal (MIPN) en Brasil. Métodos. Empleé un análisis ecológico longitudinal usando datos en panel de 4 583 municipios brasileños de 1998 al 2010, con 54 253 observaciones en total. Estimé modelos de regresión de efectos fijos por mínimos cuadrados ordinarios, con la tasa de MIPN como la variable dependiente y el PSF, el PBF y sus interacciones como las principales variables independientes de interés. Resultados. La asociación de una mayor cobertura del PSF con una menor tasa de MIPN se volvió más fuerte conforme aumentaba la cobertura del PBF. En los promedios de todas las demás variables, cuando la cobertura de PBF era 25%, la MIPN predicha fue 5,24 (intervalo de confianza [IC] de 95% = 4,95, 5,53) para una cobertura del PSF de 0%, y de 3,54 (IC de 95% = 2,77, 4,31) para una cobertura del PSF de 100%. Cuando la cobertura del PBF era de 60%, la MIPN predicha fue 4,65 (IC de 95% = 4,36, 4,94) para una cobertura del PSF de 0%, y de 1,38 (IC de 95% = 0,88, 1,89) para una cobertura del PSF de 100%. Conclusiones. El efecto del PSF depende de la ampliación del PBF. Para las poblaciones empobrecidas y subatendidas, la combinación de intervenciones tanto del lado de la oferta como del lado de la demanda podría ser necesaria para mejorar los resultados en salud.
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Affiliation(s)
- Frederico C. Guanais
- Frederico C. Guanais, PhD, División de Protección Social y Salud, Banco In-teramericano de Desarrollo, Washington, D.C., Estados Unidos de América. La correspondencia deberá enviarse a
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Stone LC, Boursaw B, Bettez SP, Marley TL, Waitzkin H. Erratum to “Place as a predictor of health insurance coverage: A multivariate analysis of counties in the United States” [Health Place 34 (2015) 207–214]. Health Place 2015; 35:155. [DOI: 10.1016/j.healthplace.2015.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Stone LC, Boursaw B, Bettez SP, Larzelere Marley T, Waitzkin H. Place as a predictor of health insurance coverage: A multivariate analysis of counties in the United States. Health Place 2015; 34:207-14. [PMID: 26086690 DOI: 10.1016/j.healthplace.2015.03.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 12/29/2014] [Accepted: 03/24/2015] [Indexed: 11/26/2022]
Abstract
This study assessed the importance of county characteristics in explaining county-level variations in health insurance coverage. Using public databases from 2008 to 2012, we studied 3112 counties in the United States. Rates of uninsurance ranged widely from 3% to 53%. Multivariate analysis suggested that poverty, unemployment, Republican voting, and percentages of Hispanic and American Indian/Alaskan Native residents in a county were significant predictors of uninsurance rates. The associations between uninsurance rates and both race/ethnicity and poverty varied significantly between metropolitan and non-metropolitan counties. Collaborative actions by the federal, tribal, state, and county governments are needed to promote coverage and access to care.
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Affiliation(s)
- Lisa Cacari Stone
- Public Health Program, Department of Family & Community Medicine, University of New Mexico Health Sciences Center, MSC 095060, 1 University, Albuquerque, NM 87131, United States; Robert Wood Johnson Foundation Center for Health Policy, University of New Mexico Health Sciences Center, MSC 095060, 1 University, Albuquerque, NM 87131, United States; Community Engagement Core, NM CARES Health Disparities Center, University of New Mexico Health Sciences Center, MSC 095060, 1 University, Albuquerque, NM 87131, United States; U.S.-Mexico Border Center of Excellence Consortium, University of New Mexico Health Sciences Center, MSC 095060, 1 University, Albuquerque, NM 87131, United States.
| | - Blake Boursaw
- College of Nursing, University of New Mexico, MSC09 5350, 1 University of New Mexico, Albuquerque, NM 87131, United States.
| | - Sonia P Bettez
- RWJF Center for Health Policy, University of New Mexico, PO Box 90, Corrales, NM 87048-0090, United States.
| | | | - Howard Waitzkin
- Robert Wood Johnson Foundation Center for Health Policy, University of New Mexico Health Sciences Center, MSC 095060, 1 University, Albuquerque, NM 87131, United States; Department of Sociology, University of New Mexico; Department of Internal Medicine, University of Illinois; School of Public Health, University of Puerto Rico, 5406 East Drive, Loves Park, IL 61111, United States.
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Almeida AHDVD, Costa MCO, Gama SGND, Amaral MTR, Vieira GO. Baixo peso ao nascer em adolescentes e adultas jovens na Região Nordeste do Brasil. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2014. [DOI: 10.1590/s1519-38292014000300009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objetivos: avaliar a associação entre as características sociodemográficas, do pré-natal e do parto de mães adolescentes e adultas jovens com o baixo peso ao nascer, em capitais e outros municípios da Região Nordeste do Brasil, no período de 2011 e 2012. Métodos: estudo transversal, de base hospitalar e nível regional, realizado em 2011 e 2012. As informações foram obtidas por meio de entrevista com a puérpera no pós-parto imediato e coletados dados dos prontuários maternos e dos recém-nascidos. Um modelo teórico conceitual foi estabelecido com três níveis de hierarquia e a variável dependente foi o baixo peso ao nascer (BPN). Resultados: do total de 3009 puérperas entrevistadas, 9,7% apresentaram conceptos com baixo peso. As puérperas que realizaram menos que seis consultas no pré-natal apresentaram uma chance 1,7 vezes maior de ter RN com baixo peso; ser primigesta aumentou a chance da ocorrência do BPN em 1,5 vezes; assim como a prematuridade que representou o principal fator de exposição, elevando em 21 vezes a chance desse desfecho. Conclusões: o estudo demonstrou alta frequência de baixo peso ao nascer entre mães adolescentes e adultas jovens, tendo como principais fatores associados o número insuficiente de consultas pré-natal, primigestação e prematuridade.
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Okafor IP, Sekoni AO, Ezeiru SS, Ugboaja JO, Inem V. Orthodox versus unorthodox care: A qualitative study on where rural women seek healthcare during pregnancy and childbirth in Southwest, Nigeria. Malawi Med J 2014; 26:45-49. [PMID: 25157317 PMCID: PMC4141242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Utilization of orthodox health facilities for maternal health services is determined by factors operating at the individual, household, community and state level. The prevalence of small family norm is one of the identified variables operating within the community which influences the decision of where to access care (orthodox/traditional). The objective of the study was to determine the use of orthodox versus unorthodox maternity healthcare and determinants among rural women in southwest Nigeria. METHODS A qualitative study was done and involved three focus group discussions. A semi-structured interview guide was used to collect information from women of reproductive age group within a rural Local Government Area in Lagos state. RESULTS Most of the women access some form of healthcare during pregnancy, orthodox, unorthodox or both. Those who patronize both services concurrently do so to benefit from the two as each has some unique features such as herbal concoctions for traditional, ultrasound and immunization of babies for orthodox. Traditional belief exerts a strong influence on decision of where to access maternal healthcare services. Actual place of delivery is determined by individual and household factors including financial resources. CONCLUSION Rural women utilize one or both orthodox and unorthodox maternal health services for different reasons. Ward Development Committees should be strengthened so as to reach the communities, educate and convince women to dispel myths which limit their use of orthodox care. Training and monitoring of Traditional Birth Attendants (TBAs) are vital to eliminate harmful practices. We also recommend improved financial access to orthodox healthcare.
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Affiliation(s)
- I P Okafor
- Department of Community Health & Primary care, College of Medicine University of Lagos Nigeria
| | - A O Sekoni
- Department of Community Health & Primary care, College of Medicine University of Lagos Nigeria
| | - S S Ezeiru
- Department of Community Health & Primary care, College of Medicine University of Lagos Nigeria
| | - J O Ugboaja
- Department of Obstetrics & Gynaecology, Nnamdi Azikiwe Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - V Inem
- Department of Community Health & Primary care, College of Medicine University of Lagos Nigeria
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Guanais FC. The combined effects of the expansion of primary health care and conditional cash transfers on infant mortality in Brazil, 1998-2010. Am J Public Health 2013; 103:2000-6. [PMID: 24028257 PMCID: PMC3828713 DOI: 10.2105/ajph.2013.301452] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES I examined the combined effects of access to primary care through the Family Health Program (FHP) and conditional cash transfers from the Bolsa Familia Program (BFP) on postneonatal infant mortality (PNIM) in Brazil. METHODS I employed longitudinal ecological analysis using panel data from 4583 Brazilian municipalities from 1998 to 2010, totaling 54,253 observations. I estimated fixed-effects ordinary least squares regressions models with PNIM rate as the dependent variable and FHP, BFP, and their interactions as the main independent variables of interest. RESULTS The association of higher FHP coverage with lower PNIM became stronger as BFP coverage increased. At the means of all other variables, when BFP coverage was 25%, predicted PNIM was 5.24 (95% confidence interval [CI] = 4.95, 5.53) for FHP coverage = 0% and 3.54 (95% CI = 2.77, 4.31) for FHP coverage = 100%. When BFP coverage was 60%, predicted PNIM was 4.65 (95% CI = 4.36, 4.94) when FHP coverage = 0% and 1.38 (95% CI = 0.88, 1.89) when FHP coverage = 100%. CONCLUSIONS The effect of the FHP depends on the expansion of the BFP. For impoverished, underserved populations, combining supply- and demand-side interventions may be necessary to improve health outcomes.
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Affiliation(s)
- Frederico C Guanais
- Frederico C. Guanais is with the Social Protection and Health Division, Inter-American Development Bank, Washington, DC
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Zhao Q, Huang ZJ, Yang S, Pan J, Smith B, Xu B. The utilization of antenatal care among rural-to-urban migrant women in Shanghai: a hospital-based cross-sectional study. BMC Public Health 2012; 12:1012. [PMID: 23170773 PMCID: PMC3577466 DOI: 10.1186/1471-2458-12-1012] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 11/12/2012] [Indexed: 12/02/2022] Open
Abstract
Background Improving utilization of antenatal care is a critical strategy for achieving China’s Millennium Development Goal of decreasing the maternal mortality ratio (MMR). While overall utilization has increased recently in China, an urban vs. rural disparity in access remains. Here we aim to assess utilization of antenatal care in rural-to-urban migrant women and identify its risk and protective factors. Methods Migrant women who had been living in Shanghai for more than six months, delivered in one of the two study hospitals between August 2009 and February 2010, and provided written consent were interviewed using a structured questionnaire. Results Of 767 women, 90.1% (691) made at least one antenatal care visit, while 49.7% (381) had adequately utilized antenatal care (i.e., made five or more antenatal care visits). Only 19.7% of women visited an antenatal care center during the first trimester (12 weeks). Women between the ages of 25 and 30 and women older than 30 were more likely than younger women to have adequately utilized antenatal care (AOR=2.2 and 1.9, 95%CI=1.4-3.5 and 1.1-3.2, respectively). Women whose husbands held Shanghai residency status (AOR=4.9, 95%CI=2.2-10.9) or who had more than 10 years of education (AOR=1.8, 95%CI=1.2-2.9), previously experienced a miscarriage or abortion (AOR=2.2, 95%CI=1.3-3.8), had higher household income (AOR=1.6, 95%CI=1.0-2.5) were more likely to have adequately utilized antenatal care. Women from high-income households were also more likely to receive antenatal care during the first 12 weeks (AOR=3.5, 95%CI=1.7-5.5). Conclusions Many migrant women in Shanghai did not receive adequate antenatal care and initiated antenatal care later than the optimal first 12 weeks of pregnancy. Poor antenatal care utilization was associated with low socioeconomic status, education, and certain demographic factors. Tailored health education for both migrant women and their husbands should be strengthened to improve maternal health. Financing supports should be provided to improve the utilization of antenatal care.
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Affiliation(s)
- Qi Zhao
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China
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Gwin KM, Schrader R, Peters K, Moreno A, Thiel KW, Leslie KK. An exploratory study of the variables impacting preterm birth rates in New Mexico. BMC Pregnancy Childbirth 2012; 12:53. [PMID: 22720802 PMCID: PMC3411409 DOI: 10.1186/1471-2393-12-53] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 06/21/2012] [Indexed: 11/24/2022] Open
Abstract
Background Preterm birth (PTB) is a substantial health problem that accounts for significant infant morbidity and mortality and poses an economic burden to both individuals and the state of residence. The goal of this study was to identify maternal risk factors for PTB in New Mexico, a poor state with a unique ethnic background, in order to identify populations at increased risk that would benefit from intervention. Methods This was a cross-sectional retrospective exploratory analysis of 377,770 singleton live births in the state of New Mexico from 1991-2005. Gestational age of less than 37 weeks was defined as PTB. The Kotelchuck Index was used as a measure for level of prenatal care described as inadequate, intermediate, adequate, and intensive. Results Of the live births analyzed, 28,036 of these were preterm (7.4%). Overall the PTB rate rose at a rate of 0.18% per year from 1991-2005. Among patients with medical risk factors, the absence of prenatal care was associated with higher odds for PTB as compared to adequate prenatal care. Other risk factors were unmarried status, education less than high school, tobacco/alcohol use, black, Asian, and white Hispanic ethnicity, and the presence of one or more medical risk factors. Statistically significant protective factors for PTB were age 25-29, education surpassing high school, and Native American race. Conclusions This study identified several factors that correlate with increased PTB in New Mexico, in particular ethnicity and level of prenatal care. The finding that Native American patients have a lower PTB rate compared to other groups, even though this group is traditionally one of low socioeconomic status in New Mexico, signifies that other factors yet to be identified affect PTB.
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Affiliation(s)
- Kara M Gwin
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA
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Aremu O, Lawoko S, Dalal K. The Influence of Individual and Contextual Socioeconomic Status on Obstetric Care Utilization in the Democratic Republic of Congo: A Population-based Study. Int J Prev Med 2012; 3:278-85. [PMID: 22624085 PMCID: PMC3354398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 11/01/2011] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Maternal health care utilization continues to focus on the agenda of health care planners around the world, with high attention being paid to the developing countries. The devastating effect of maternal death at birth on the affected families is untold. This study examines the utilization of obstetric care in the Democratic Republic of Congo. METHODS We have used the nationally representative data from the 2007. Democratic Republic of Congo Demographic and Health Survey. Multilevel regression analysis has been applied to a nationally representative sample of 6,695 women, clustered around 299 communities in the country. RESULTS The results show that there are variations in the use of antenatal care and delivery care. Individual-level characteristics, such as women's occupation and household wealth status are shown to be associated with the use of antenatal care. Uptake of facility-based delivery has been seen to be dependent on the household wealth status, women's education, and partner's education. The effect of the neighborhoods' socioeconomic disadvantage on the use of antenatal care and facility-based delivery are the same. Women from highly socioeconomically disadvantaged communities, compared to their counterparts from less socioeconomically disadvantaged neighborhoods, are less likely to utilize both the antenatal services and healthcare facility for child delivery. The result of this study has shown that both individual and contextual socioeconomic status play an important role in obstetric care uptake. CONCLUSION Thus, intervention aimed at improving the utilization of obstetrics care should target both the individual economic abilities of the women and that of their environment when considering the demand side.
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Affiliation(s)
- Olatunde Aremu
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Scotland,Health Economics Research Unit, University of Aberdeen, Aberdeen, Scotland,Correspondence to: Dr. Olatunde Aremu, Health Economist, Health Economics Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland, E-mail:
| | - Stephen Lawoko
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Scotland
| | - Koustuv Dalal
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Scotland,Medical and Health Sciences, Center for Medical Technology Assessment, Linkoping, Sweden, Scotland
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