Review of Health Systems of the Middle East and North Africa Region

Countries in the Middle East and North Africa (MENA) region share important sociocultural features but also differ significantly on a number of dimensions, including methods and approaches to addressing the health of their national populations. This article is a systematic analysis of the health systems of the region, including a review of health patterns and services to address them. A number of health systems dimensions are discussed, including the organization of biomedical and traditional medical services, access to health services, financing and resourcing mechanisms, and leadership and governance issues. Current and future challenges that need to be addressed by countries to ensure more efficient and responsive systems are also reviewed.

Home birth in women who have given birth at least once in a health facility: contributory factors in a developing country

OBJECTIVE

To study the link between patients' satisfaction about received services in health facilities and the choice of future delivery place of women who had delivered at least once in a facility.

DESIGN

Cross-sectional study.

SETTING

Health district Gossas in Senegal.

SAMPLE

Three hundred and seventy-three women who gave birth in the last 12 months.

METHODS

Data were collected using a questionnaire during an interview. Logistic regression was used to explore the determinants of childbirth at home using the Andersen behavioral model.

MAIN OUTCOME MEASURES

Place of delivery and satisfaction at reception and conduct of delivery.

RESULTS

The average age was 28±6years. Among the women interviewed, 97% were married, 53% being in a polygamous system, and 18% were educated. Forty-seven per cent of them were satisfied with the quality of the last delivery made within a health facility. The prevalence of home birth was 22%. Home births were more frequent among women in a polygamous marriage [odds ratio (OR) 1.85; 95% confidence interval (CI) 1.01-3.14], with no means of transportation (OR 1.68; 95% CI 1.02-3.95) and who lived more than 5km from a health facility (OR 2.24; 95% CI 1.21-4.15). Poor quality of delivery in a health facility (OR 2.52; 95% CI 1.36-4.65) or a delivery done by a male provider (OR 3.90; 95% CI 2.30-6.65) were also risk factors for the choice of home delivery.

CONCLUSIONS

Particular emphasis should be placed on training healthcare providers to improve the quality of service provided to patients in health facilities.