Health service resources as determinants of infant death in rural Bangladesh: an empirical study

Prevalence and factors associated with antenatal care utilization in Ethiopia: an evidence from demographic health survey 2016

BACKGROUND

Ethiopia is one of the sub-Saharan African country with high maternal mortality ratio (MMR). According to Ethiopian demographic health survey (EDHS) 2016 report, MMR is 420 among 100,000 live births. Antenatal care utilization is a key intervention to reduce these deaths through problem detection and treatment, promotion of health seeking behavior, and preparing pregnant women for birth. Therefore, this study aimed to assess prevalence and factors associated with antenatal care service utilization in Ethiopia in 2016.

METHODS

Secondary data analysis was done on EDHS 2016. It was a stratified, two-stage, and cluster sampling design. Analysis has been restricted to antenatal care utilization among women who delivered at least one time in the past five years. Data were weighted to correct sampling bias. Moreover, complex data analysis was done. Bi-variate and multivariable logistic regression analyses were carried out. Adjusted odds ratio with 95% confidence interval was computed and P-value less than 0.05 considered as a statistically significance level for identification of association.

RESULTS

Prevalence of antenatal care utilization was 62.8% [95%CI: 60.9, 64.6] in this study. Maternal educational status of primary school (AOR = 1.8,95%CI:1.2, 2.6), maternal educational status of secondary school (AOR = 4.4,95%CI: 1.1, 17.3), women who listen radio less than 1 per week (AOR = 1.9,95%CI:1.12,3.34), women who listen radio at least 1 per week (AOR = 2.6,95%CI:1.4,4.8), women in rich wealth quintile (AOR = 1.9,95%CI: 1.1, 3.2) were factors positively associated with antenatal care utilization. However, women who had traditional belief (AOR = 0.1,95%CI:0.02,0.49), and women who had five children and above (AOR = 0.6,95%CI: 0.3, 0.9) were factors associated negatively with antenatal care utilization.

CONCLUSIONS

Prevalence of antenatal care utilization is still low in Ethiopia in 2016. Maternal higher maternal educational status, frequent radio listening, higher wealth quintile, traditional belief, and greater number of children were found to be associated significantly with antenatal care utilization. Consequently, socio-economic status should be enhanced, information should be accessed by women about antenatal care utilization and family planning service through mass media. Furthermore, intensive community education program should be designed for traditional believers to increase uptake of antenatal care by stakeholders.

Factors influencing antenatal care service utilization in hadiya zone

Background

In Ethiopia, the levels of maternal and infant morbidity and mortality are among the highest in the world. This is attributed to, among other factors, none use of modern health care services by women in Ethiopia. According to the 2005 Ethiopian Demographic Health Survey, more than seven in ten mothers did not receive antenatal care at all. Therefore, the objective of this study was to explore factors influencing antenatal care services utilization in Southern Ethiopia.

Methods

A community-based cross sectional study was conducted in Hadiya Zone of Southern Ethiopia from January to February 2009. A multi stage sampling technique was used to select the study population in one urban and five rural kebeles. Analysis was done using SPSS for windows version 16.

Result

This study revealed that antenatal care service utilization in the study area was 86.3%. However, from those who attended antenatal care service 406 (68.2%) started antenatal care visit during the second trimester of pregnancy and significant proportion 250 (42%) had less than four visits. Maternal age, husband attitude, family size, maternal education, and perceived morbidity were major predictors of antenatal care service utilization.

Conclusion

Though the antenatal care service utilization is high in the study population, four in ten of the mothers did not have the minimum number of visits recommended by World Health Organization. Promoting information, education and communication in the community is recommended to favorably affect the major predictors of antenatal care service utilization.

Proximity to health services and child survival in low- and middle-income countries: a systematic review and meta-analysis

OBJECTIVES

Few studies have systematically examined the effects of barriers such as distance to health facilities on child survival in low- and middle-income countries. Our primary objective was to estimate the effect of proximity to health facilities on child survival in low- and middle-income countries. The secondary objective was to compare effects in different age categories (perinatal (28 weeks of gestation to 1 week of age), neonatal (0-27 days), infant (0-11 months) and child (0-59 months) mortality).

DESIGN

A systematic review and meta-analysis was conducted of studies published from 1980 to 2012 that assessed the effect of proximity to health facilities on child survival in low- and middle-income countries. Synthesis was by random-effects meta-analysis, and variation between studies was investigated by meta-regression.

SETTING

Low- and middle-income countries.

PARTICIPANTS

13 studies were included in the meta-analysis, 11 from low-income and two from middle-income countries and none were from remote areas.

PRIMARY OUTCOME MEASURES

The primary outcome measures of interest were perinatal, neonatal, infant and child mortality.

RESULTS

Overall, children who lived farthest from health facilities were more likely to die compared with those who lived closer (OR 1.32, 95% CI 1.19 to 1.47). This effect appeared stronger during the perinatal (OR 2.76, 95% CI 1.80 to 4.24) and neonatal (OR 1.98, 95% CI 1.43 to 2.72) periods compared with the infant (OR 1.18, 95% CI 1.0 to 1.38) and under-5 (OR 1.20, 95% CI 1.04 to 1.39) periods.

CONCLUSIONS

Proximity to health facilities appears to be an important determinant of under-5 mortality in low- and middle-income countries, especially in the perinatal and neonatal periods. Higher quality studies are needed, which examine the effect of access to health services on child survival, especially studies from remote areas and hard to reach populations.

Physical accessibility and utilization of health services in Yemen

Background

Assessment of physical access to health services is extremely important for planning. Complex methods that incorporate data inputs from road networks and transport systems are used to assess physical access to healthcare in industrialised countries. However, such data inputs hardly exist in many developing countries. Straight-line distances between the service provider and resident population are easily obtained but their relationship with driving distance and travel time is unclear. This study aimed to investigate the relationship between different measures of physical access, including straight-line distances, road distances and travel time and the impact of these measures on the vaccination of children in Yemen.

Methods

Coordinates of houses and health facilities were determined by GPS machine in Urban and rural areas in Taiz province, Yemen. Road distances were measured by an odometer of a vehicle driven from participants' houses to the nearest health centre. Driving time was measured using a stop-watch. Data on children's vaccination were collected by personal interview and verified by inspecting vaccination cards.

Results

There was a strong correlation between straight-line distances, driving distances and driving time (straight line distances vs. driving distance r = 0.92, p < 0.001, straight line distances vs. driving time r = 0.75; p < 0.001, driving distance vs. driving time r = 0.83, p < 0.001). Each measure of physical accessibility showed strong association with vaccination of children after adjusting for socio-economic status.

Conclusion

Straight-line distances, driving distances and driving time are strongly linked and associated with vaccination uptake. Straight-line distances can be used to assess physical access to health services where data inputs on road networks and transport are lacking. Impact of physical access is clear in Yemen, highlighting the need for efforts to target vaccination and other preventive healthcare measures to children who live away from health facilities.

Delivery complications and healthcare-seeking behaviour: the Bangladesh Demographic Health Survey, 1999-2000

Maternal health services have a potentially critical role in the improvement of reproductive health. The use of health services is related to the availability, quality and cost of the services, as well as to social structure, health beliefs and the personal characteristics of the users. The present paper examined the factors that influence the use of maternal health services for some selected pregnancy-related complications (e.g. prolonged labour, excessive bleeding, high fever/discharge and convulsions) in Bangladesh by using data from the Bangladesh Demographic Health Survey, 1999-2000. It was found that younger mothers were significantly less likely to seek professional healthcare at the time of birth. The odds for rural women seeking healthcare services from a doctor, nurse and/or midwife were half those of urban women. The strong influence of the mothers' education and parity on the utilisation of healthcare services is consistent with findings from other studies. The possession of assets emerged as an important predictor of seeking care from health professionals at the time of birth. Another factor, i.e. a husband's concern about pregnancy complications, showed a significant and positive impact on the utilisation of healthcare services, which is very important for rural women when they are dependent on their spouses. It was observed that the respondents living in urban areas, who had higher levels of education and lower parity, and more assets (used as a proxy for income), visited trained healthcare providers more often and were more likely to use healthcare facilities provided by trained personnel at the time of delivery. This is a reflection of the fact that, irrespective of their needs, only people from higher economic or educational groups can afford to seek healthcare from trained personnel in Bangladesh. In other words, predisposing and enabling factors appear to have a strong association with women's healthcare utilisation during pregnancy.

Utilisation of postnatal care in Bangladesh: evidence from a longitudinal study

Utilisation of health services is a complex behavioural phenomenon. Empirical studies of preventive and curative services in Bangladesh have often showed that the use of health services is related to the availability, quality and cost of services, as well as to social structure, health beliefs and personal characteristics of the users. The present paper attempts to examine factors associated with the utilisation of healthcare services during the postnatal period in Bangladesh by using prospective data from a survey on maternal morbidity in Bangladesh, conducted by the Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Technologies (BIRPERT). Both bivariate and multivariate analyses of the data confirmed that the mother's age at marriage had a significant and positive impact on the utilisation of quality healthcare services. The husband's occupation also showed a strong impact on healthcare utilisation, indicating higher use of quality care for postpartum morbidity by wives of business and service workers. The bivariate analysis showed that the number of pregnancies prior to the index pregnancy and desired pregnancies are significantly associated with the utilisation of postpartum healthcare. However, the results of this study were inconclusive on the influence of other predisposing and enabling factors, such as maternal education, the number of previous pregnancies, the occupation of the husband, antenatal care visits during pregnancy and access to health facilities. Multivariate logistic regression estimates did not show any significant impact of these factors on the use of maternal healthcare.

Utilization of health facilities and trained birth attendants for childbirth in rural Bangladesh: an empirical study

The majority of births in rural Bangladesh are carried out in unhygienic conditions by relatives and traditional birth attendants (TBAs). This results in a high incidence of maternal and infant mortality that could be reduced if childbirth were to occur in health centers or under the supervision of trained TBAs (TTBAs). In this paper, we examined factors associated with utilization of modern health resources for childbirth in 39 villages of Bangladesh. We followed a retrospective survey research design to collect relevant information from couples who experienced childbirth during a two-year period from July 1, 1995 to June 1997. The data indicate that slightly over 11% of the deliveries were performed by trained personnel with the rest attended by TBAs. Multivariate analysis clearly shows that delivery complications was the most significant factor determining the use of modern health care resources for childbirth, followed by parental education, and pre-natal care. We conclude that quick response to delivery complications and improved access to hospitals and TTBAs can reduce the risk of infant and maternal mortality and morbidity in rural Bangladesh.

Is the Turkish health care system ready to be a part of the European Union?

Lately, Turkey is struggling to recover from the economic effects of the economic crisis so that the government officials are trying to impose budget cuts in health and education sectors. After the United States, the country's national defense expenditures are the highest among the NATO countries. Therefore, Turkey allocates only 3-4% of the gross domestic product for health care expenses. Overall, the health status in Turkey is the lowest among the European Union countries; infant mortality rate is about 45 per 1000 live births, which is the highest on the European continent, and per capita health care expenditure is $120. Although 75% of the people are covered by some type of public insurance, 25% of the Turkish people do not have any insurance coverage. The national system is funded by taxes (43%), out of pocket payments (32%), and social and private insurance premiums (25%). This study examines whether Turkey is ready to be a part of the European Union in terms of the health sector of its economy and health status of its people.

Infant mortality among various nationalities in the middle part of Guizhou, China

This paper describes infant mortality, leading causes of death, and some associated factors among the Han, the Miao, the Bouyei and other minority nationalities in three counties of the middle part of Guizhou Province, China. The results showed that the overall infant mortality rate (IMR) in these areas was 125.7 per 1000 live births during 1985-1987. There existed a great disparity in IMR among different nationalities. The rate was 103.1 (Han), 148.8 (Miao), 161.2 (Bouyei) and 145.0 (other ethnic groups) per 1000 live births, respectively. The five leading causes of death in infants were respiratory diseases, neonatal tetanus, birth asphyxia, infectious diseases and diarrhoea. These causes of death combined resulted in an IMR of 104.1 per 1000 live births. However, these diseases varied in importance for infants of different nationalities. We considered the relationship between infant death and maternal and child health care. The location of birth, the kinds of birth attendants and utilization of health facilities might be associated with differentials of infant mortality among these nationalities. Maternal education was associated with infant survival, but it might not be the only factor in decreasing or eliminating the differential of IMR among various nationalities. Based upon the findings, it is urgent to improve maternal and child health care and investigate further cultural and sociological factors among various nationalities.

Distance from the Primary Health Center: a GIS method to study geographical access to health care

Aerial distance from the dependent Primary Health Center is a crude but objective measure of geographical accessibility to Primary Health care facilities. This report describes a method for calculation of distances between the PHC and the population it serves using the data available from the local health authorities and the Swedish Central Statistical Bureau. The Swedish annual population registration records of 1991 and the property register available with the Central Statistical Bureau of Sweden formed the main data sources. By coupling the address in the population register to the property register each individual was mapped to the centroid of a property. The location of the PHCs as well as the areas covered by each were obtained from the local health authorities and mapped. By intersecting the population coverage with the PHC coverage the population for each PHC area was identified. Subsequently the distance to the PHC was calculated for each individual (property centroid). The population maps so generated can be linked to other databases to visualize and analyze the spatial dimension of health and disease. The methodology can be adapted for use with postal code districts, census enumeration tracts, or any other small area.