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Zhu W, Zhu C, Min H, Li L, Wang X, Wu J, Zhu X, Gu C. Status of the midwifery workforce and childbirth services and the impact of midwife staffing on birth outcomes in China: a multicentre cross-sectional study. BMJ Open 2024; 14:e082527. [PMID: 38692722 DOI: 10.1136/bmjopen-2023-082527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVE To investigate the status of the midwifery workforce and childbirth services in China and to identify the association between midwife staffing and childbirth outcomes. DESIGN A descriptive, multicentre cross-sectional survey. SETTING Maternity hospitals from the eastern, central and western regions of China. PARTICIPANTS Stratified sampling of maternity hospitals between 1 July and 31 December 2021.The sample hospitals received a package of questionnaires, and the head midwives from the participating hospitals were invited to fill in the questionnaires. RESULTS A total of 180 hospitals were selected and investigated, staffed with 4159 midwives, 412 obstetric nurses and 1007 obstetricians at the labour and delivery units. The average efficiency index of annual midwifery services was 272 deliveries per midwife. In the sample hospitals, 44.9% of women had a caesarean delivery and 21.4% had an episiotomy. Improved midwife staffing was associated with reduced rates of instrumental vaginal delivery (adjusted β -0.032, 95% CI -0.115 to -0.012, p<0.05) and episiotomy (adjusted β -0.171, 95% CI -0.190 to -0.056, p<0.001). CONCLUSION The rates of childbirth interventions including the overall caesarean section in China and the episiotomy rate, especially in the central region, remain relatively high. Improved midwife staffing was associated with reduced rates of instrumental vaginal delivery and episiotomy, indicating that further investments in the midwifery workforce could produce better childbirth outcomes.
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Affiliation(s)
- Wenli Zhu
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- School of Nursing, Fudan University, Shanghai, China
| | - Chunxiang Zhu
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Hui Min
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Lingling Li
- Department of Gynecology and Obstetrics, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xiaojiao Wang
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jiangnan Wu
- Clinical Research Center, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xinli Zhu
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Chunyi Gu
- Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
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Asumadu ODK, Boah M, Chirawurah D, Ndago JA, Yakong VN, Kanligi DA, Adokiya MN. Pregnancy outcomes before and during COVID-19 pandemic in Tamale Metropolis, Ghana: A retrospective cohort study. PLoS One 2024; 19:e0302589. [PMID: 38687775 PMCID: PMC11060567 DOI: 10.1371/journal.pone.0302589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 04/08/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic affected expectant mothers seeking maternal health services in most developing countries. Access and utilization of maternal health services including antenatal care (ANC) attendance and skilled delivery declined drastically resulting in adverse pregnancy outcomes. This study assessed pregnancy outcomes before and during COVID-19 pandemic in Tamale Metropolis, Ghana. METHODS/DESIGN A retrospective cohort study design was employed. A random sampling technique was used to select 450 women who delivered before or during the COVID-19 pandemic in Tamale Metropolis, Ghana. The respondents were interviewed using structured questionnaire at their homes. In this study, the data collected were socio-demographics characteristics, ANC attendance, before or during pandemic delivery, place of delivery and birth outcomes. Chi-square test and bivariate logistic regression analyses were performed under significant level of 0.05 to determine factors associated with the outcome variables. RESULT Of the 450 respondents, 51.8% were between 26 and 30 years of age. More than half (52.2%) of the respondents had no formal education and 93.3% were married. The majority (60.4%) of the respondents described their residence as urban setting. About 31.6% of the women delivered before the pandemic. The COVID-19 pandemic influenced place of delivery. The proportion of women who attended at least one ANC visit (84.5% before vs 70.5% during), and delivered at a hospital (76.8% before vs 72.4% during) were higher before the pandemic. More women were likely to deliver at home during COVID-19 (OR: 2.38, 95%CI: 1.52-3.74, p<0.001). Similarly, there was statistically significance difference between before and during COVID-19 delivery on at least one ANC attendance (OR: 2.72, 95%CI: 1.58-1.67, p<0.001). Women who delivered during COVID-19 were about twice more likely to develop complications (OR: 1.72, 95%CI: 1.03-2.87, p = 0.04). CONCLUSION ANC attendance and health facility delivery decreased while pregnancy complications increased during COVID-19. During disease outbreaks, outreach engagement strategies should be devised to increase access and utilization of maternal health services for marginalized and underserved populations. The capacity of health workers should be strengthened through skills training to manage adverse birth outcomes.
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Affiliation(s)
- Obed Duah Kwaku Asumadu
- Department of Social and Behavioural Change, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Michael Boah
- Department of Epidemiology, Biostatistics and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Dennis Chirawurah
- Department of Occupational and Environmental Health, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Joyce Aputere Ndago
- Department of Social and Behavioural Change, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Vida Nyagre Yakong
- Department of Preventive Health Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - David Abatanie Kanligi
- Pediatric Unit, Savelugu Municipal Hospital, Ghana Health Service, Tamale, Northern Region, Ghana
| | - Martin Nyaaba Adokiya
- Department of Epidemiology, Biostatistics and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
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Leal MDC, Esteves-Pereira AP, Bittencourt SA, Domingues RMSM, Theme Filha MM, Leite TH, Ayres BVDS, Baldisserotto ML, Nakamura-Pereira M, Moreira MEL, Gomes MADSM, Dias MAB, Takemoto MLS, Pacagnella RDC, Gama SGND. Protocol of Birth in Brazil II: National Research on Abortion, Labor and Childbirth. CAD SAUDE PUBLICA 2024; 40:e00036223. [PMID: 38695459 PMCID: PMC11057480 DOI: 10.1590/0102-311xpt036223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/26/2023] [Accepted: 08/07/2023] [Indexed: 05/06/2024] Open
Abstract
Brazil has made advances in obstetric care in public and private hospitals; however, weaknesses in this system still require attention. The Brazilian Ministry of Health, aware of this need, funded the second version of the Birth in Brazil survey. This study aimed to evaluate: prenatal, labor and birth, postpartum, and abortion care, comparing the results with those of Birth in Brazil I; and analyze the main determinants of perinatal morbidity and mortality; evaluate the care structure and processes of obstetrics and neonatology services in maternity hospitals; analyze the knowledge, practices, and attitudes of health professionals who provide birth and abortion care; and identify the main barriers and facilitators related to care of this nature in Brazil. With a national scope and a 2-stage probability sample: 1-hospitals and 2-women, stratified into 59 strata, 465 hospitals were selected with a total planned sample of around 24,255 women - 2,205 for abortion reasons and 22,050 for labor reasons. Data collection was conducted using six electronic instruments during hospital admission for labor or abortion, with two follow-up waves, at two and four months. In order to expand the number of cases of severe maternal morbidity, maternal and perinatal mortality, three case control studies were incorporated into Birth in Brazil II. The fieldwork began in November 2021 and is scheduled to end in 2023. It will allow a comparison between current labor and birth care results and those obtained in the first study and will evaluate the advances achieved in 10 years.
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Affiliation(s)
- Maria do Carmo Leal
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | | | | | | | | | | | | | - Marcos Nakamura-Pereira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Maria Elisabeth Lopes Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Marcos Augusto Bastos Dias
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Minani P, Ross A. Strengthening caesarean birth: Sub-Saharan Africa health system evaluation: Scoping review. Afr J Prim Health Care Fam Med 2024; 16:e1-e11. [PMID: 38708736 DOI: 10.4102/phcfm.v16i1.4128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Promoting safe caesarean birth (CB) is a challenge in sub-Saharan Africa (SSA) where maternal and neonatal mortality rates are high due to inadequate maternal health services. Although the CB rate in SSA is lower than the World Health Organization (WHO) recommendation, it is often associated with high maternal and neonatal mortality. AIM The aim of this scoping review was to report on the extent to which SSA health systems deliver safe CB. METHODS A systematic search across various databases identified 53 relevant studies, comprising 30 quantitative, 10 qualitative and 16 mixed methods studies. RESULTS These studies focused on clinical protocols, training, availability, accreditation, staff credentialing, hospital supervision, support infrastructure, risk factors, surgical interventions and complications related to maternal mortality and stillbirth. CB rates in SSA varied significantly, ranging from less than 1% to a high rate of 29.7%. Both very low as well as high rates contributed to significant maternal and neonatal morbidity. Factors influencing maternal and perinatal mortality include poor referral systems, inadequate healthcare facilities, poor quality of CBs, inequalities in access to maternity care and affordable CB intervention. CONCLUSION The inadequate distribution of healthcare facilities, and limited access to emergency obstetric care impacted the quality of CBs. Early access to quality maternity services with skilled providers is recommended to improve CB safety.Contributions: This scoping review contributes to the body of knowledge motivating for the prioritization of maternal service across SSA.
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Affiliation(s)
- Patrick Minani
- Department of Public Health Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban.
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Jeganathan G, Srinivasan SK, Ramasamy S, Govindharaj P. Accessibility and availability of maternal and reproductive health care services: ensuring health equity among rural women in Southern India. BMC Prim Care 2024; 25:145. [PMID: 38684970 PMCID: PMC11059574 DOI: 10.1186/s12875-024-02369-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/08/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION The health of women is of particular concern because they often have greater health needs than men and many women still lack access to quality healthcare services, preventing their ability to attain the best possible level of health. Hence, this study aimed to assess the accessibility and availability of health services among rural women. METHODS A household survey was conducted by using a multi-stage sample with 407 married women aged 18-45 years, having at least one child and living in Tiruchirappalli District, Tamil Nadu were recruited for this study. A semi-structured questionnaire was used to collect data about the demographic status, and accessibility and availability of health services. RESULTS Of the 407 respondents, 70% were aged between 26 and 40 years, 73% were working as farmers and labourers and 77% were living in nuclear families. 71% of them had enjoyed hospital facilities near their residence and 83% of the hospitals were run by the government. In village health nurse service (VHN), 34% of the respondents had received all services from VHN and 86% did not face any kind of gender inequality and almost all of them were satisfied with the service provided by the VHN. Almost all the respondents (98%) were satisfied with the availability of health services and 92% of them benefited from the government scheme related to childbirth. CONCLUSION This study showed that overall, the women were satisfied with the availability of healthcare services and reproductive health services. Moreover, almost all of them benefited from the government scheme related to childbirth.
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Affiliation(s)
| | - Sampath Kumar Srinivasan
- Department of Sociology & Population Studies, Bharathiar University, Coimbatore, Tamil Nadu, India
| | - Senthilkumar Ramasamy
- Health System Strengthening, State Health Resource Centre, Raipur, Chhattisgarh, 492001, India
| | - Pitchaimani Govindharaj
- Department of Allied Health Sciences, Sri Ramachandra Institute of Higher Education and Research (DU), Chennai, Tamil Nadu, India.
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Zhang J, Li H, Wei B, He R, Zhu B, Zhang N, Mao Y. Association between maternal health service utilization and under-five mortality rate in China and its provinces, 1990-2017. BMC Pregnancy Childbirth 2024; 24:326. [PMID: 38671364 PMCID: PMC11055253 DOI: 10.1186/s12884-024-06437-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The United Nations (UN) Sustainable Development Goal - 3.2 aims to eliminate all preventable under-five mortality rate (U5MR). In China, government have made efforts to provide maternal health services and reduce U5MR. Hence, we aimed to explore maternal health service utilization in relation to U5MR in China and its provinces in 1990-2017. METHODS We obtained data from Global Burden of Disease 2017, China Health Statistics Yearbook, China Statistical Yearbook, and Human Development Report China Special Edition. The trend of U5MR in each province of China from 1990 to 2017 was analyzed using Joinpoint Regression model. We measured the inequities in maternal health services using HEAT Plus, a health inequity measurement tool developed by the UN. The generalized estimating equation model was used to explore the association between maternal health service utilization (including prenatal screening, hospital delivery and postpartum visits) and U5MR. RESULTS First, in China, the U5MR per 1000 live births decreased from 50 in 1990 to 12 in 2017 and the average annual percentage change (AAPC) was - 5.2 (p < 0.05). Secondly, China had a high maternal health service utilization in 2017, with 96.5% for prenatal visits, 99.9% for hospital delivery, and 94% for postnatal visits. Inequity in maternal health services between provinces is declining, with hospital delivery rate showing the greatest decrease (SII, 14.01 to 1.87, 2010 to 2017). Third, an increase in the rate of hospital delivery rate can significantly reduce U5MR (OR 0.991, 95%CI 0.987 to 0.995). Postpartum visits rate with a one-year lag can reduce U5MR (OR 0.993, 95%CI 0.987 to 0.999). However, prenatal screening rate did not have a significant effect on U5MR. CONCLUSION The decline in U5MR in China was associated with hospital delivery and postpartum visits. The design and implementation of maternal health services may provide references to other low-income and middle-income countries.
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Affiliation(s)
- Jingya Zhang
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi , 710049, China
| | - Haoran Li
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi , 710049, China
| | - Bincai Wei
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, 518055, China
| | - Rongxin He
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China
| | - Bin Zhu
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, 518055, China
| | - Ning Zhang
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China.
| | - Ying Mao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi , 710049, China.
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Chewaka MT, Ayele G, Tessema GY, Dinagde DD, Afework HT, Biwota BM, Wada HW. Hidden cost of hospital-based delivery and associated factors among postpartum women attending public hospitals in Gamo zone, southern Ethiopia. BMC Health Serv Res 2024; 24:495. [PMID: 38649915 PMCID: PMC11034158 DOI: 10.1186/s12913-024-10927-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 03/28/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Since 2005, the healthcare system in Ethiopia has implemented policies to promote the provision of free maternal healthcare services. The primary goal of these policies is to enhance the accessibility of maternity care for women from various socioeconomic backgrounds. Additionally, the aim is to increase the utilization of maternity services, such as institutional deliveries, by removing financial obstacles that pregnant women may face. Even though maternity services are free of charge. The hidden cost has unquestionably been a key obstacle in seeking and utilizing health care services. Significant payments due to delivery services could create a heavy economic burden on households. OBJECTIVES To determine the hidden cost of hospital-based delivery and associated factors among postpartum women attending public hospitals in Gamo zone, southern Ethiopia 2023. METHODS A facility-based cross-sectional study was conducted on 411 postpartum women in Gamo Zone Public Health Hospitals from December 1, 2022, to January 30, 2023. The systematic sampling technique was applied to reach study units. Data was collected using the Kobo Toolbox Data Collection Tool and exported to SPSS statistical software version 27 for analysis. Simple linear regression and multiple linear regression were done to see the association of variables. The significance level was declared at a P-value < 0.05 in the final model. RESULT The median hidden cost of hospital-based delivery was 1142 Ethiopian birr (ETB), with a range (Q) of 2262 (504-2766) ETB. Monthly income of the family (β = 0.019), obstetrics complications (β = 0.033), distance from the health facility (β = 0.003), and mode of delivery (β = 0.072), were positively associated with the hidden cost of hospital-based delivery. While, rural residence (β = -0.041) was negatively associated with the outcome variable. CONCLUSION This study showed the hidden cost of hospital based delivery was relatively high. Residence, monthly income of the family, obstetric complications, mode of delivery, and distance from the health facility were statistically significant. It is important to take these factors into account when designing health intervention programs and hospitals should prioritize the availability of essential drugs and medical supplies within their facilities to address direct medical costs in hospitals.
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Affiliation(s)
- Menen Tilahun Chewaka
- Department of Midwifery, College of Health Sciences, Mizan Tepi University, Mizan Tepi, Ethiopia.
| | - Gistane Ayele
- Department of Midwifery, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Godana Yaya Tessema
- Department of Midwifery, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Dagne Deresa Dinagde
- Departments of Midwifery, College of Health Sciences, Mattu University, Mettu, Ethiopia.
| | - Hana Tadesse Afework
- Department of Midwifery, College of Health Sciences, Mizan Tepi University, Mizan Tepi, Ethiopia
| | - Bezalem Mekonen Biwota
- Department of Midwifery, College of Health Sciences, Mizan Tepi University, Mizan Tepi, Ethiopia
| | - Habtamu Wana Wada
- Department of Midwifery, Arba Minch Health Sciences College, Arba Minch, Ethiopia
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Ghatak S, Dutta M. Utilizing maternal healthcare services: are female-headed households faring poorly? BMC Pregnancy Childbirth 2024; 24:299. [PMID: 38649989 PMCID: PMC11034127 DOI: 10.1186/s12884-024-06445-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Utilization of maternal healthcare services has a direct bearing on maternal mortality but is contingent on a wide range of socioeconomic factors, including the sex of the household head. This paper studies the role of the sex of the household head in the utilization of maternal healthcare services in India using data from the National Family Health Survey-V (2019-2021). METHODS The outcome variable of this study is maternal healthcare service utilization. To that end, we consider three types of maternal healthcare services: antenatal care, skilled birth assistance, and postnatal care to measure the utilization of maternal healthcare service utilization. The explanatory variable is the sex of the household head and we control for specific characteristics at the individual level, household-head level, household level and spouse level. We then incorporate a bivariate logistic regression on the variables of interest. RESULTS 24.25% of women from male-headed households have complete utilization of maternal healthcare services while this proportion for women from female-headed households stands at 22.39%. The results from the bivariate logistic regression confirm the significant impact that the sex of the household head has on the utilization of maternal healthcare services in India. It is observed that women from female-headed households in India are 19% (AOR, 0.81; 95% CI: 0.63,1.03) less likely to utilize these services than those from male-headed households. Moreover with higher levels of education, there is a 25% (AOR, 1.25; 95% CI: 1.08,1.44) greater likelihood of utilizing maternal healthcare services. Residence in urban areas, improved wealth quintiles and access to healthcare facilities significantly increases the chances of maternal healthcare utilization. The interaction term between the sex of the household head and the wealth quintile the household belongs to, (AOR, 1.39; 95% CI: 1.02, 1.89) shows that the utilization of maternal healthcare services improves when the wealth quintile of the household improves. CONCLUSION The results throw light on the fact that the added expenditure on maternal healthcare services exacerbates the existing financial burden for the economically vulnerable female-headed households. This necessitates the concentration of research and policy attention to alleviate these households from the sexual and reproductive health distresses. TRIAL REGISTRATION Not Applicable. JEL CLASSIFICATION D10, I12, J16.
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Affiliation(s)
- Subhasree Ghatak
- Research Scholar, Department of Humanities and Social Sciences, Indian Institute of Technology Patna, Patna, India.
| | - Meghna Dutta
- Assistant Professor of Economics, Department of Humanities and Social Sciences, Indian Institute of Technology Patna, Patna, India
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Shibre G, Mekonnen W, Haile Mariam D. Explaining changes in educational disparities in competent maternal health care services in urban and rural areas in Ethiopia. Front Public Health 2024; 12:1332801. [PMID: 38680926 PMCID: PMC11045905 DOI: 10.3389/fpubh.2024.1332801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/19/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Aggregate statistics of maternal health care services have improved in Ethiopia. Nevertheless, the country has one of the lowest Universal Health Coverage (UHC) service coverage indices, with slight improvement between 2000 and 2019. There are disparity studies that focus on a single dimension of inequality. However, studies that combine multiple dimensions of inequality simultaneously may have important policy implications for closing inequalities. In this study, we investigated education inequalities in the receipt of maternal health care services in rural and urban areas separately, and we examined whether these inequalities decreased, increased, or remained unchanged. Methods The data for the study came from the 2011 and 2016 Ethiopia Demographic and Health Surveys. Using women's education as a dimension of inequality, we separately analyzed inequalities in maternal health care services in urban and rural settings. Inequalities were measured through the Erreygers concentration index, second differences, and Relative Index of Inequality (RII). Whether inequalities changed over time was analyzed by relative and absolute measures. An Oaxaca-type decomposition approach was applied to explain changes in absolute disparities over time. Results There were glaring educational disparities in maternal health care services in urban and rural areas, where the services were more concentrated among women with better schooling. The disparities were more severe in urban than in rural areas. In urban areas, skilled birth service was the most unequal in both periods. Disparities in rural places were roughly similar for all services except that in 2011, postnatal care was the least unequal, and in 2016, skilled birth was the most unequal services. Trend analyses revealed that disparities significantly dropped in urban by absolute and relative measures. Conversely, in rural regions, the disparities grew by the concentration index measure for most services. The RII and second differences presented conflicting results regarding whether the gaps were increasing, shrinking, or remaining the same. Conclusion Substantial disparities in maternal health care services remained and even increased, as in rural areas. Different and targeted strategies are needed for urban and rural places to close the observed educational inequalities in these areas.
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Affiliation(s)
- Gebretsadik Shibre
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wubegzier Mekonnen
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Damen Haile Mariam
- Department of Health Systems Management and Health Policy, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Anderer S. More Than Half of US Rural Hospitals No Longer Offer Birthing Services-Here's Why. JAMA 2024; 331:815-817. [PMID: 38381424 DOI: 10.1001/jama.2024.1278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
This Medical News article discusses a new report on labor and delivery department closures in the rural US as well as potential financial and workforce solutions.
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Abstract
This Viewpoint discusses the National Institutes of Health initiative that focuses on research that reduces preventable maternal mortality, decreases severe maternal morbidity, and promotes health equity.
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Affiliation(s)
- Diana W Bianchi
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Janine A Clayton
- Office of Research on Women's Health, National Institutes of Health, Bethesda, Maryland
| | - Shannon N Zenk
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland
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Kota K, Chomienne MH, Geneau R, Yaya S. Socio-economic and cultural factors associated with the utilization of maternal healthcare services in Togo: a cross-sectional study. Reprod Health 2023; 20:109. [PMID: 37488593 PMCID: PMC10367352 DOI: 10.1186/s12978-023-01644-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/02/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Proper utilization of maternal healthcare services plays a major role on pregnancy and birth outcomes. In sub-Saharan Africa, maternal and child mortality remains a major public health concern, especially in least developed countries such as Togo. In this study, we aimed to analyze factors associated with use of maternal health services among Togolese women aged 15-49 years. METHODS This study used data from third round of nationally representative Demographic and Health Survey conducted in Togo in 2013. Analysis included 4,631 women aged 15-49 years. Outcome variables were timely first antenatal care (ANC) visits, adequate ANC4 + visits, and health facility delivery. Data were analyzed using Stata version 16. RESULTS Overall, proportion of maternal healthcare utilization was 27.53% for timely first ANC visits, 59.99% for adequate ANC visits, and 75.66% for health facility delivery. Our multivariable analysis showed significant differences among women in highest wealth quintile, especially in rural areas with increasing odds of timely first ANC visits (Odds ratio (OR) = 3.46, 95% CI = 2.32,5.16), attending adequate ANC visits (OR = 2.19, 95% CI = 1.48,3.24), and delivering in health facilities (OR = 8.53, 95% CI = 4.06, 17.92) compared to those in the poorest quintile. Also, women with higher education had increased odds of timely first ANC visits (OR = 1.37, 95% CI = 1.11,1.69), and attending adequate ANC visits (OR = 1.73, 95% CI = 1.42,2.12) compared to those with no formal education. However, having higher parity and indigenous beliefs especially in rural areas decreased odds of using healthcare services. CONCLUSIONS Findings from this study showed that socio-economic inequality and socio-cultural barriers influenced the use of maternal healthcare services in Togo. There is therefore a need to improve accessibility and the utilization of maternal healthcare services through women's economic empowerment and education to reduce the barriers.
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Affiliation(s)
- Komlan Kota
- Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON Canada
| | - Marie-Hélène Chomienne
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Robert Geneau
- Applied Research Division, Public Health Agency of Canada, Ottawa, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON K1N 6N5 Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Daalderop LA, Been JV, Steegers EAP, Bertens LCM. Impact of the EURO-PERISTAT Reports on obstetric management: a difference-in-regression-discontinuity analysis. Eur J Public Health 2023; 33:342-348. [PMID: 36807668 PMCID: PMC10066490 DOI: 10.1093/eurpub/ckad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Population health monitoring, such as perinatal mortality and morbidity rankings published by the European Perinatal Health (EURO-PERISTAT) reports may influence obstetric care providers' decision-making and professional behaviour. We investigated short-term changes in the obstetric management of singleton term deliveries in the Netherlands following publication of the EURO-PERISTAT reports in 2003, 2008 and 2013. METHODS We used a quasi-experimental difference-in-regression-discontinuity approach. National perinatal registry data (2001-15) was used to compare obstetric management at delivery in four time windows (1, 2, 3 and 5 months) surrounding publication of each EURO-PERISTAT report. RESULTS The 2003 EURO-PERISTAT report was associated with higher relative risks (RRs) for an assisted vaginal delivery across all time windows [RR (95% CI): 1 month: 1.23 (1.05-1.45), 2 months: 1.15 (1.02-1.30), 3 months: 1.21 (1.09-1.33) and 5 months: 1.21 (1.11-1.31)]. The 2008 report was associated with lower RRs for an assisted vaginal delivery at the 3- and 5-month time windows [0.86 (0.77-0.96) and 0.88 (0.81-0.96)]. Publication of the 2013 report was associated with higher RRs for a planned caesarean section across all time windows [1 month: 1.23 (1.00-1.52), 2 months: 1.26 (1.09-1.45), 3 months: 1.26 (1.12-1.42) and 5 months: 1.19(1.09-1.31)] and lower RRs for an assisted vaginal delivery at the 2-, 3- and 5-month time windows [0.85 (0.73-0.98), 0.83 (0.74-0.94) and 0.88 (0.80-0.97)]. CONCLUSIONS This study showed that quasi-experimental study designs, such as the difference-in-regression-discontinuity approach, are useful to unravel the impact of population health monitoring on decision-making and professional behaviour of healthcare providers. A better understanding of the contribution of health monitoring to the behaviour of healthcare providers can help guide improvements within the (perinatal) healthcare chain.
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Affiliation(s)
- Leonie A Daalderop
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jasper V Been
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Division of Neonatology, Department of Paediatrics, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Loes C M Bertens
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Escobar MF, Echavarria MP, Vasquez H, Nasner D, Ramos I, Hincapié MA, Pabon S, Kusanovic JP, Martínez-Ruíz DM, Carvajal JA. Experience of a telehealth and education program with maternal and perinatal outcomes in a low-resource region in Colombia. BMC Pregnancy Childbirth 2022; 22:604. [PMID: 35906534 PMCID: PMC9336139 DOI: 10.1186/s12884-022-04935-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/19/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Maternal morbidity and mortality rates associated with perinatal care remain a significant public health concern. Rural populations from low and middle-income countries have multiple barriers to access that contribute to a lack of adherence to prenatal care, and high rates of maternal mortality and morbidity. An intervention model based on telehealth and education was implemented between a tertiary high complex care hospital and a second-level hospital from a limited source region. OBJECTIVES We sought to identify an association in maternal and perinatal care quality indicators after implementing a model based on telehealth and education for patients with obstetric emergencies between two hospitals in a southwestern region of Colombia. METHODS We conducted an ecological study between 2017 and 2019 to compare before and after obstetric emergency care through telemedicine from a secondary care center (Hospital Francisco de Paula Santander-HFPS) to the referral center (Fundación Valle del Lili-FVL). The intervention included verification visits to determine the installed capacity of care, a concerted improvement plan, and on-site educational training modules in obstetric and perinatal care. RESULTS There were 102 and 148 patients treated before and after telemedicine implementation respectively. Clinical indicators after model implementation showed a reduction in perinatal mortality of 29%. In addition, a reduction in the need for transfusion of blood products due to postpartum hemorrhage was observed as well as the rate of eclampsia. CONCLUSIONS Implementing a model based on telehealth and education between secondary and tertiary care centers allowed the strengthening of the security of care in obstetric emergencies and had a positive effect on perinatal mortality.
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Affiliation(s)
- María Fernanda Escobar
- High Complexity Obstetric Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cra 98 Nro.18-49, Cali, 760032, Colombia.
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia.
- Department of Telemedicine, Fundación Valle del Lili, Cra 98 Nro.18-49, Cali, 760032, Colombia.
| | - María Paula Echavarria
- High Complexity Obstetric Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cra 98 Nro.18-49, Cali, 760032, Colombia
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Hilda Vasquez
- High Complexity Obstetric Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cra 98 Nro.18-49, Cali, 760032, Colombia
- Department of Telemedicine, Fundación Valle del Lili, Cra 98 Nro.18-49, Cali, 760032, Colombia
| | - Daniela Nasner
- Department of Telemedicine, Fundación Valle del Lili, Cra 98 Nro.18-49, Cali, 760032, Colombia
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra 98 Nro.18-49, Cali, 760032, Colombia
| | - Isabella Ramos
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - María Antonia Hincapié
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Stephanie Pabon
- High Complexity Obstetric Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cra 98 Nro.18-49, Cali, 760032, Colombia
| | - Juan Pedro Kusanovic
- Department of Obstetrics and Gynecology, Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF), Hospital Sótero del Río, Santiago, Chile
- Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Javier Andrés Carvajal
- High Complexity Obstetric Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cra 98 Nro.18-49, Cali, 760032, Colombia
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
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Asim M, Hameed W, Saleem S. Do empowered women receive better quality antenatal care in Pakistan? An analysis of demographic and health survey data. PLoS One 2022; 17:e0262323. [PMID: 34990479 PMCID: PMC8735593 DOI: 10.1371/journal.pone.0262323] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 12/22/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Quality antenatal care is a window of opportunity for improving maternal and neonatal outcomes. Numerous studies have shown a positive effect of women empowerment on improved coverage of maternal and reproductive health services, including antenatal care (ANC). However, there is scarce evidence on the association between women's empowerment and improved ANC services both in terms of coverage and quality. Addressing this gap, this paper examines the relationship between multi-dimensional measures of women empowerment on utilization of quality ANC (service coverage and consultation) in Pakistan. METHODS We used Pakistan Demographic and Health Survey 2017-18 (PDHS) data which comprises of 6,602 currently married women aged between 15-49 years who had a live birth in the past five years preceding the survey. Our exposure variables were three-dimensional measures of women empowerment (social independence, decision making, and attitude towards domestic violence), and our outcome variables were quality of antenatal coverage [i.e. a composite binary measure based on skilled ANC (trained professional), timeliness (1st ANC visit during first trimester), sufficiency of ANC visits (4 or more)] and quality of ANC consultation (i.e. receiving at least 7 or more essential antenatal components out of 8). Data were analysed in Stata 16.0 software. Descriptive statistics were used to describe sample characteristics and binary logistic regression was employed to assess the association between empowerment and quality of antenatal care. RESULTS We found that 41.4% of the women received quality ANC coverage and 30.6% received quality ANC consultations during pregnancy. After controlling for a number of socio-economic and demographic factors, all three measures of women's empowerment independently showed a positive relationship with both outcomes. Women with high autonomy (i.e. strongly opposed the notion of violence) in the domain of attitude to violence are 1.66 (95% CI 1.30-2.10) and 1.45 (95% CI 1.19-1.75) and times more likely to receive antenatal coverage and quality ANC consultations respectively, compared with women who ranked low on attitude to violence. Women who enjoy high social independence had 1.87 (95% CI 1.44-2.43) and 2.78 (95% CI 2.04-3.79) higher odds of quality antenatal coverage and consultations respectively, as compared with their counterparts. Similarly, women who had high autonomy in household decision making 1.98 (95% CI 1.60-2.44) and 1.56 (95% CI 2.17-1.91) were more likely to receive quality antenatal coverage and consultation respectively, as compared to women who possess low autonomy in household decision making. CONCLUSION The quality of ANC coverage and consultation with service provider is considerably low in Pakistan. Women's empowerment related to social independence, gendered beliefs about violence, and decision-making have an independent positive association with the utilisation of quality antenatal care. Thus, efforts directed towards empowering women could be an effective strategy to improve utilisation of quality antenatal care in Pakistan.
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Affiliation(s)
- Muhammad Asim
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Waqas Hameed
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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16
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Kabir MR. Adopting Andersen's behavior model to identify factors influencing maternal healthcare service utilization in Bangladesh. PLoS One 2021; 16:e0260502. [PMID: 34843566 PMCID: PMC8629289 DOI: 10.1371/journal.pone.0260502] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/10/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Equitable maternal healthcare service access and it's optimum utilization remains a challenge for many developing countries like Bangladesh, and different predisposing, enabling, and need-based factors affect the level of maternal healthcare use. The evidently poor maternal healthcare service utilization and disparities among groups in Bangladesh are concerning considering its effect on maternal health outcomes. The study aimed to identify the factors that influence maternal healthcare service (MHS) utilization in Bangladesh by adopting Andersen's behavior model of health service use as the theoretical framework. METHODS The 2017-18 Bangladesh Demographic Health Survey (2017-18 BDHS) data were used which is nationally representative. The survey study used two-stage stratified sampling to select study households, and data were collected through face-to-face interviews. The desirable, moderate, and undesirable maternal health service (MHS) package was developed based on antenatal, and delivery care services use during pregnancy and childbirth. Multinomial logistic regression and discriminant analysis were performed to analyze the factors that affect MHS use. RESULTS Out of 5,011 ever-married women, only 31.2% of women utilized the desirable level of MHS. The likelihood of using the desirable level of MHS package, relative to the undesirable category, was 9.38 times (OR: 9.38, 95% CI: 4.30-20.44) higher for women with a higher level of education compared to illiterate women, and the same trend was noticed for husband's education. The wealth index had the highest standardized function coefficients (Beta coefficient: 0.49) in discriminatory function. Women with the richest wealth index were more than 23 times (OR: 23.27, 95% CI: 12.69-42.68) likely to have utilized desirable MHS than their poorest counterparts. The likelihood of service uses also varied according to the child's birth order, administrative regions, and area of residence (rural vs. urban). CONCLUSIONS Policies and interventions directed towards poverty reduction, universal education, and diminishing geographical disparities of healthcare access might influence the desirable use of maternal healthcare services in Bangladesh.
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Affiliation(s)
- Md. Ruhul Kabir
- School of Communication, Hong Kong Baptist University, Kowloon Tong, Hong Kong
- Department of Food Technology & Nutrition Science, Noakhali Science & Technology University, Noakhali, Bangladesh
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Feroze N, Ziad MA, Fayyaz R, Gaba YU. Bayesian Analysis of Trends in Utilization of Maternal Healthcare Services in Pakistan during 2006-2018. Comput Math Methods Med 2021; 2021:4691477. [PMID: 34873415 PMCID: PMC8643246 DOI: 10.1155/2021/4691477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/08/2021] [Accepted: 11/17/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVES This study is aimed at investigating the time trends and disparities in access to maternal healthcare in Pakistan using Bayesian models. Study Design. A longitudinal study from 2006 to 2018. METHODS The detailed analysis is based on the data from Pakistan Demographic and Health Survey (PDHS) conducted during 2006-2018. We have proposed Bayesian logistic regression models (BLRM) to investigate the trends of maternal healthcare in the country. Based on different goodness-of-fit criteria, the performance of proposed models has also been compared with repeatedly used classical logistic regression models (CLRM). RESULTS The results from the analysis suggested that BLRM perform better than CLRM. The access to antenatal healthcare increased from 61% to 86% during years 2006-18. The utilization of medication also improved from 44% in 2006 to 60% in 2018. Despite the improvements from 2006 to 2018, every three out of ten women were not protected against neonatal tetanus, neither delivered in the health facility place nor availed with the skilled health provider at the time of delivery during 2018. Similarly, two-fifth mothers did not received any skilled postnatal checkup within two days after delivery. Additionally, the likelihood of MHS provided to mothers is in favor of mothers with lower ages, lower birth orders, urban residences, higher education, higher wealth quintiles, and residents of Sindh and Punjab. CONCLUSIONS The gaps in utilization of MHS in different socioeconomic groups of the society have not decreased significantly during 2006-2018. Any future maternal health initiative in the country should focus to reduce the observed disparities among different socioeconomic sectors of the society.
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Affiliation(s)
- Navid Feroze
- Department of Statistics, The University of Azad Jammu and Kashmir, Muzaffarabad, Pakistan
| | - Muhammad Ajmal Ziad
- Department of Statistics, The University of Azad Jammu and Kashmir, Muzaffarabad, Pakistan
| | - Rabia Fayyaz
- COMSATS University Islamabad, Islamabad, Pakistan
| | - Yaé Ulrich Gaba
- Quantum Leap Africa (QLA), AIMS Rwanda Centre, Remera Sector KN 3, Kigali, Rwanda
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Chen Y, Shi J, Zhu Y, Kong X, Lu Y, Chu Y, Mishu MM. Women with maternal near-miss in the intensive care unit in Yangzhou, China: a 5-year retrospective study. BMC Pregnancy Childbirth 2021; 21:784. [PMID: 34798869 PMCID: PMC8602992 DOI: 10.1186/s12884-021-04237-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Analysis of "maternal near-misses" is expected to facilitate assessment of the quality of maternity care in health facilities. Therefore, this study aimed to investigate incidence, risk factors and causes of maternal near-misses (MNM) admitted to the intensive care unit (ICU) within five years by using the World Health Organization's MNM approach. METHODS A five-year retrospective study was conducted in Subei People's Hospital of Yangzhou, Jiangsu Province from January 1, 2015 to December 31, 2019. Risk factors in 65 women with MNM in the intensive care unit (ICU) were explored by using chi-square tests and multivariable logistic regression analysis. Causes and interventions in MNM were investigated by descriptive analysis. RESULTS Average maternal near-miss incidence ratio (MNMIR) for ICU admission was 3.5 per 1000 live births. Average maternal mortality ratio (MMR) was 5 per 100,000 live births. MI for all MNM was 0.7%. Steady growth of MNMIR in ICU was witnessed in the five-year study period. Women who were referred from other hospitals (aOR 3.32; 95%CI 1.40-7.32) and had cesarean birth (aOR 4.96; 95%CI 1.66-14.86) were more likely to be admitted in ICU. Neonates born to women with MNM admitted in ICU had lower birthweight (aOR 5.41; 95%CI 2.53-11.58) and Apgar score at 5 min (aOR 6.39; 95%CI 2.20-18.55) compared with women with MNM outside ICU. ICU admission because of MNM occurred mostly postpartum (n = 63; 96.9%). Leading direct obstetric causes of MNM admitted in ICU were hypertensive diseases of pregnancy (n = 24; 36.9%), followed by postpartum hemorrhage (n = 14; 21.5%), while the leading indirect obstetric cause was heart diseases (n = 3; 4.6%). CONCLUSIONS Risk factors that were associated with MNM in ICU were referral and cesarean birth. Hypertensive disease of pregnancy and postpartum hemorrhage were the main obstetric causes of MNM in ICU. These findings would provide guidance to improve professional skills of primary health care providers and encourage vaginal birth in the absence of medical indications for cesarean birth.
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Affiliation(s)
- Ying Chen
- School of Nursing, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Jiaoyang Shi
- Department of Obstetrics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Yuting Zhu
- School of Nursing, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Xiang Kong
- Department of Obstetrics and Gynecology, Medical College of Yangzhou University, Yangzhou, Jiangsu Province, China.
| | - Yang Lu
- Medical College of Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Yanru Chu
- Ningbo Center for Disease Control and Prevention, Ningbo, China
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Souza DRS, de Morais TNB, Costa KTDS, de Andrade FB. Maternal health indicators in Brazil: A time series study. Medicine (Baltimore) 2021; 100:e27118. [PMID: 34871202 PMCID: PMC8568415 DOI: 10.1097/md.0000000000027118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/14/2021] [Accepted: 08/17/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT In addition to the maternal death indicator, Stork Network proposes the number of prenatal consultations, the gestational age of onset of prenatal care and the number of children breastfeeding.The study aims to analyze maternal health indicators representative of the actions proposed by Stork Network in Brazil, after its implementation. Therefore, this is an ecological study of maternal health indicators in Brazil from 2012 to 2017.Thus, it was found that the number of prenatal consultations per pregnant woman in Brazil from 2012 to 2017 increased >4 times between the first and the last year analyzed. The proportion of pregnant women who started prenatal care in the first trimester of pregnancy increased progressively each year in Brazil.The breastfeeding coefficient also increased progressively between 2014 and 2017 in Brazil. It was found that maternal health indicators improved between 2012 and 2017 in the Brazilian territory.
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Affiliation(s)
- Dandara Rayssa Silva Souza
- Nurse. Master in Collective Health. Postgraduate Program in Public Health. Federal University of Rio Grande do Norte, Natal, Brazil
| | | | | | - Fábia Barbosa de Andrade
- Nurse. Doctor of Health Sciences. Department of Nurse. Federal University of Rio Grande do Norte, Natal, Brazil
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Thapa JK, Stöckl D, Sangroula RK, Pun A, Thapa M, Maskey MK, Delius M. Investment case approach for equitable access to maternal neonatal and child health services: Stakeholders' perspective in Nepal. PLoS One 2021; 16:e0255231. [PMID: 34610036 PMCID: PMC8491871 DOI: 10.1371/journal.pone.0255231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/12/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Investment Case is a participatory approach that has been used over the years for better strategic actions and planning in the health sector. Based on this approach, a District Investment Case (DIC) program was launched to improve maternal, neonatal and child health services in partnership with government, non-government sectors and UNICEF Nepal. In the meantime, this study aimed to explore perceptions and experiences of local stakeholders regarding health planning and budgeting and explore the role of the DIC program in ensuring equity in access to maternal and child health services. METHODS This study adopted an exploratory phenomenography design with a purposive sampling technique for data collection. Three DIC implemented districts and three comparison districts were selected and total 30 key informant interviews with district level stakeholders and six focus groups with community stakeholders were carried out. A deductive approach was used to explore the perception of local stakeholders of health planning and budgeting of the health care expenses on the local level. RESULTS Investment Case approach helped stakeholders in planning systematically based on evidence through collaborative and participatory approach while in comparison areas previous year plan was mainly primarily considered as reference. Resource constraints and geographical difficulty were key barriers in executing the desired plan in both intervention and comparison districts. Positive changes were observed in coverage of maternal and child health services in both groups. A few participants reported no difference due to the DIC program. The participants specified the improvement in access to information, access and utilization of health services by women. This has influenced the positive health care seeking behavior. CONCLUSIONS The decentralized planning and management approach at the district level helps to ensure equity in access to maternal, newborn and child health care. However, quality evidence, inclusiveness, functional feedback and support system and local resource utilization should be the key consideration.
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Affiliation(s)
- Janak Kumar Thapa
- CIH, Center for International Health, Ludwig-Maximilians-University, Munich, Germany
- * E-mail: ,
| | - Doris Stöckl
- Helmholtz Zentrum Muenchen, University Hospital, LMU Munich, Munich, Germany
| | - Raj Kumar Sangroula
- Nepal Public Health Research and Development Center (PHRD Nepal), Kathmandu, Nepal
| | | | | | | | - Maria Delius
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
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MOUHOUMED HAMDAMOHAMED, MEHMET NIMETCAN. Utilization pattern of antenatal care and determining factors among reproductive-age women in Borama, Somaliland. J Prev Med Hyg 2021; 62:E439-E446. [PMID: 34604585 PMCID: PMC8451356 DOI: 10.15167/2421-4248/jpmh2021.62.2.1882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/07/2021] [Indexed: 11/16/2022]
Abstract
Background Antenatal care is essential care given during pregnancy, to diagnose and treat complications that could endanger both the lives of mother and child. The risk of dying from pregnancy-related issues is often associated with a lack of access to antenatal care services. This issue is a prominent matter in developing countries such as Somaliland which has one of the highest maternal mortality rates in the world. Objective The objective of this study is to determine the frequency and timing of antenatal care utilization and factors influencing it among reproductive-age women. Methods A population-based cross-sectional survey is conducted among 330 randomly selected mothers who gave birth in the past two years in Borama, Somaliland. Result Although a significant number of women utilized antenatal care in their pregnancy only 31.1% initiated the first visit within the first trimester and 48.3% received less than the recommended four visits. Fewer antenatal care visits are significantly associated with age (OR = 3.018; CI = 1.264-7.207), gravida (OR = 3.295; CI = 1.200-9.045), and gestation age (OR = 1.737; CI = 1.013-2.979). Early marriage (OR=0.495; CI = 0.252-0.973), and large family size (OR = 3.952; CI = 1.330-11.742) are associated with delay in the commencement of the first antenatal care visit. Conclusion Young women, women with multiple pregnancies, women married at a young age, and women with a large family size have a higher probability of delaying prenatal care and having fewer visits. Based on the findings, uplifting the socioeconomic status and literacy level of women through community-based education and developing strategies that would take the determining factors into account may contribute to improved and adequate utilization of antenatal care.
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Affiliation(s)
- HAMDA MOHAMED MOUHOUMED
- Correspondence: Hamda Mohamed Mouhoumed, Yildirim Beyazit University, Department of Public Health, Ayvalı Mah. 150 Sk. Etlik-Keçiören, Ankara, Turkey - E-mail:
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22
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Abstract
BACKGROUND AND OBJECTIVES The aim was to explore the association between community health centers' (CHC) distance to a "maternity care desert" (MCD) and utilization of maternity-related health care services, controlling for CHC and county-level factors. MEASURES Utilization as: total number of CHC visits to obstetrician-gynecologists, certified nurse midwives, family physicians (FP), and nurse practitioners (NP); total number of prenatal care visits and deliveries performed by CHC staff. RESEARCH DESIGN Cross-sectional design comparing utilization between CHCs close to MCDs and those that were not, using linked 2017 data from the Uniform Data System (UDS), American Hospital Association Survey, and Area Health Resource Files. On the basis of prior research, CHCs close to a "desert" were hypothesized to provide higher numbers of FP and NP visits than obstetrician-gynecologists and certified nurse midwives visits. The sample included 1261 CHCs and all counties in the United States and Puerto Rico (n=3234). RESULTS Results confirm the hypothesis regarding NP visits but are mixed for FP visits. CHCs close to "deserts" had more NP visits than those that were not. There was also a dose-response effect by MCD classification, with NP visits 3 times higher at CHCs located near areas without any outpatient and inpatient access to maternity care. CONCLUSIONS CHCs located closer to "deserts" and NPs working at these comprehensive, primary care clinics have an important role to play in providing access to maternity care. More research is needed to determine how best to target resources to these limited access areas.
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Affiliation(s)
- Anne R. Markus
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University
| | - Drishti Pillai
- National Asian Pacific American Women’s Forum, Washington, DC
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Kebede AA, Cherkos EA, Taye EB, Eriku GA, Taye BT, Chanie WF. Married women's decision-making autonomy in the household and maternal and neonatal healthcare utilization and associated factors in Debretabor, northwest Ethiopia. PLoS One 2021; 16:e0255021. [PMID: 34570781 PMCID: PMC8476028 DOI: 10.1371/journal.pone.0255021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 07/09/2021] [Indexed: 11/18/2022] Open
Abstract
Background Women’s decision-making autonomy is very crucial for the improvement of women empowerment, and maternal, neonatal, and child healthcare utilization. As time immemorial, Ethiopian culture is largely gender stratified, and the position of women is subordinate to men in various household and health-seeking decision-making matters. However, there is a dearth of empirical evidence on women’s decision-making autonomy, especially in the household and on maternal and newborn healthcare utilization. Therefore, this study assessed married women’s decision-making autonomy in the household and on maternal and neonatal healthcare utilization and associated factors in Debretabor, Northwest Ethiopia. Methods A community-based cross-sectional study was conducted from October 1st to 30th, 2019. A two-stage sampling technique was used to select 730 married women. Data were collected using a structured, pretested, and interviewer-administered questionnaire. Data were entered into EPI INFO 7 and analyzed by SPSS version 23. Multivariable logistic regression model was fitted to identify factors associated with women’s decision-making autonomy in the household and maternal and neonatal healthcare utilization. The adjusted odds ratio with its 95% confidence interval was computed to determine the level of significance at a p-value of ≤ 0.05. Results A total of 730 married women were included in the analysis. Thus, three-fourths (75.1%) of women had higher decision-making autonomy on their health, neonatal health, and other socio-economic aspects. Besides, the proportion of four and above antenatal visits, delivery at a health facility, postnatal checkup, knowledge of neonatal danger signs, and appropriate health-seeking practices for sick newborns among autonomous women were 52.1%, 56.1%, 71.4%, 32%, and 80% respectively. Age greater than 35 years old (AOR = 2.08; 95% CI: 1.19, 3.62), monthly income of > 5000 ETB (AOR = 3.1; 95% CI: 1.36, 7.07), husband involvement (AOR = 2.36; 95% CI: 1.55, 3.43), and adequate knowledge of neonatal danger signs (AOR = 2.11; 95% CI: 1.4, 3.2) were factors independently associated with women’s decision-making autonomy on maternal and neonatal healthcare utilization and other socio-economic affairs. Conclusion Our findings show that women’s decision-making autonomy in the household and maternal and neonatal healthcare utilization was optimal. Increasing household income level, promotion of husband’s involvement starting from the prenatal period, and increasing women’s knowledge of maternal and neonatal danger signs will have a great role in the improvement of women’s decision-making autonomy.
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Affiliation(s)
- Azmeraw Ambachew Kebede
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Endeshaw Admasu Cherkos
- Department of Women’s and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eden Bishaw Taye
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getachew Azeze Eriku
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Birhan Tsegaw Taye
- Department of Midwifery, College of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Wagaye Fentahun Chanie
- UNFPA Supported Maternal Health Project Coordinator, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Buser JM, Moyer CA, Boyd CJ, Veliz PT, Zulu D, Ngoma-Hazemba A, Mtenje JT, Jones AD, Lori JR. The Association Between Maternity Waiting Home Use and Maternal-Newborn Knowledge: Latent Class Analysis. J Nurs Meas 2021; 29:334-346. [PMID: 33795487 DOI: 10.1891/jnm-d-19-00093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE An exploratory latent class analysis (LCA) was performed assessing the association between maternity waiting home (MWH) use and maternal-newborn care knowledge. METHODS A two-group comparison design using a face-to-face interview (n = 250) was conducted to understand if MWH use was associated with greater maternal knowledge of newborn care. RESULTS High levels of maternal knowledge of newborn care were associated with MWH use. Mothers with low levels of knowledge were less likely to use an MWH prior to delivery and more likely to have fewer pregnancies, attend less than four antenatal care (ANC) visits, and receive no education about newborn health problems during ANC. CONCLUSIONS Nurses need to target younger, primigravida mothers attending fewer ANC visits with educational opportunities while advocating for expansion of health education at MWHs to potentiate long-term benefits for improved maternal-newborn health and delivery outcomes.
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Affiliation(s)
| | | | | | | | - Davy Zulu
- Republic of Zambia Ministry of Health, Lundazi, Zambia
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Li D, Yu C, Song C, Ning W, Xu Y, Ge H, Lin S, Zhou W, Lu Y, Wang X, Hu Z, Lin Y, Wu J. Maternal mortality ratio in Jiangsu Province, China: recent trends and associated factors. BMC Pregnancy Childbirth 2021; 21:447. [PMID: 34172025 PMCID: PMC8235612 DOI: 10.1186/s12884-021-03897-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/17/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In recent years, births to older mothers and multiparous mothers have increased rapidly with the change of birth policy in China. And mothers of advanced age are more likely to have maternal complications and poor birth outcomes. We aimed to estimate the recent trends and underlying risk factors of maternal mortality. METHODS In this systematic assessment, we used data from the National Maternal and Child Health Routine Reporting System (2013-2018), Jiangsu Provincial Maternal Mortality Surveillance System (2017-2018), the Integrated National Mortality Surveillance System (2018), City Statistical Yearbooks (2018), City Health Statistical Yearbooks (2018). The factors associated with maternal mortality ratio (MMR) were explored using the stepwise regression analysis and cluster analysis. RESULTS The MMR maintained at low levels between 2013 and 2016 and there was a slight increase in maternal mortality after 2016 in Jiangsu province. With the implementation of the China's universal two child policies, the percentage of multiparous mothers ascended from 34.2% (95% confidence interval (CI) = 34.1-34.3%) in 2013 to 51.4% (95% CI = 51.3-51.6%) in 2018 (beta = 3.88, P < 0.001). Consistently, the percentage of advanced maternal age (≥ 35) increased from 8.4% (95% CI = 8.4-8.5%) in 2013 to 10.4% (95% CI = 10.3-10.4%) in 2018 (beta = 0.50, P = 0.012). And we found that the percentage of multiparous mothers and advanced maternal age among maternal deaths were higher than all pregnant women (P < 0.001). In the stepwise regression analysis, four risk factors were significantly associated with maternal mortality ratio (primary industry of gross domestic product (GDP), rate of delivery in maternal and child health hospital, rate of cesarean section and rate of low birth weight). As the results derived from cluster analysis, the relatively developed regions had lower preventable maternal mortality ratio (43.5% (95% CI = 31.2-56.7%) vs. 62.6% (95% CI = 52.3-72.0%), P = 0.027). CONCLUSIONS Since the universal two child policy has been associated with changes in health related birth characteristics: women giving birth have been more likely to be multiparous, and more likely to be aged 35 and over. This somewhat magnifies the impact of differences in economic development and obstetric services on MMR. The findings based on prefecture level data suggest that interventions must target economic development, the health system and maternal risk factors in synergy. These approaches will be of great benefit to control or diminish environmental factors associated with preventable deaths and will effectively reduce MMR and narrow the gap among the different regions.
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Affiliation(s)
- Donghua Li
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Jiangsu Women and Children Health Hospital, Nanjing, 210036, China
| | - Chengxiao Yu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Ci Song
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Weiqing Ning
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Jiangsu Women and Children Health Hospital, Nanjing, 210036, China
| | - Yan Xu
- Department of Women and Children, Jiangsu Provincial Commission of Health, Nanjing, 210008, China
| | - Huan Ge
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Jiangsu Women and Children Health Hospital, Nanjing, 210036, China
| | - Song Lin
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Jiangsu Women and Children Health Hospital, Nanjing, 210036, China
| | - Wenjie Zhou
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Jiangsu Women and Children Health Hospital, Nanjing, 210036, China
| | - Yajun Lu
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Jiangsu Women and Children Health Hospital, Nanjing, 210036, China
| | - Xudong Wang
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Jiangsu Women and Children Health Hospital, Nanjing, 210036, China
| | - Zhibin Hu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Yuan Lin
- Department of Maternal, Child and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
| | - Jie Wu
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Jiangsu Women and Children Health Hospital, Nanjing, 210036, China.
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Daniele MAS. Male partner participation in maternity care and social support for childbearing women: a discussion paper. Philos Trans R Soc Lond B Biol Sci 2021; 376:20200021. [PMID: 33938279 PMCID: PMC8090816 DOI: 10.1098/rstb.2020.0021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 12/28/2022] Open
Abstract
Male partners/fathers are key support persons for many childbearing women and their involvement in pregnancy, childbirth and the postpartum/postnatal period has beneficial effects on a wide range of outcomes related to maternal and child health and family wellbeing. Social support is implicated in the relevant causal pathway, but has received largely tangential attention in the public health literature. This discussion paper aims to reframe men's participation in maternity care as an opportunity to enhance their readiness and ability to provide social support to women, contributing to the debate on the definition and rationale for male partner involvement, and paving the way for further empirical work. I begin by presenting a theory of change illustrating the causal pathway leading from male partner participation, through the key intermediate step of social support, to improved health and wellbeing for women and children. I proceed by arguing that many people desire male partner participation in maternity care; however, in practice, this is often limited owing to cultural, social and institutional barriers. I use examples from the intervention literature to demonstrate how participation in care can boost men's motivation to support women and enhance their ability to do so by increasing their knowledge and skills. Finally, I draw up general implications for further male partner involvement programmes, suggesting that in order to achieve meaningful and sustainable gains, attention to design is crucial in order to avoid reinforcing patriarchal gender norms. Programmes should be implemented alongside other efforts to improve quality and promote woman-centred care. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.
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van Manen ELM, Hollander M, Feijen-de Jong E, de Jonge A, Verhoeven C, Gitsels J. Experiences of Dutch maternity care professionals during the first wave of COVID-19 in a community based maternity care system. PLoS One 2021; 16:e0252735. [PMID: 34138877 PMCID: PMC8211230 DOI: 10.1371/journal.pone.0252735] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/21/2021] [Indexed: 11/19/2022] Open
Abstract
Background and objective During the COVID-19 pandemic the organization of maternity care changed drastically; this study into the experiences of maternity care professionals with these changes provides suggestions for the organization of care during and after pandemics. Design An online survey among Dutch midwives, obstetricians and obstetric residents. Multinomial logistic regression analyses were used to investigate associations between the respondents’ characteristics and answers. Results Reported advantages of the changes were fewer prenatal and postpartum consultations (50.1%). The necessity and safety of medical interventions and ultrasounds were considered more critically (75.9%); 14.8% of community midwives stated they referred fewer women to the hospital for decreased fetal movements, whereas 64.2% of the respondents working in hospital-based care experienced fewer consultations for this indication. Respondents felt that women had more confidence in giving birth at home (57.5%). Homebirths seemed to have increased according to 38.5% of the community midwives and 65.3% of the respondents working in hospital-based care. Respondents appreciated the shift to more digital consultations rather than face-to-face consultations. Mentioned disadvantages were that women had appointments alone, (71.1%) and that the community midwife was not allowed to join a woman to obstetric-led care during labour and subsequently stay with her (56.8%). Fewer postpartum visits by family and friends led to more tranquility (59.8%). Overall, however, 48.0% of the respondents felt that the safety of maternity care was compromised due to policy changes. Conclusions Maternity care professionals were positive about the decrease in routine care and the increased confidence of women in home birth, but also felt that safety in maternity care was sometimes compromised. According to the respondents in a future crisis situation it should be possible for community midwives to continue to deliver a personal handover after the referral of women to the hospital, and to stay with them.
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Affiliation(s)
- Eline L. M. van Manen
- Department of Obstetrics, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
- * E-mail:
| | - Martine Hollander
- Department of Obstetrics, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Esther Feijen-de Jong
- Midwifery Science, AVAG (Academy Midwifery Amsterdam and Groningen), Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of General Practice & Elderly Medicine, AVAG (Academy Midwifery Amsterdam and Groningen), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ank de Jonge
- Midwifery Science, AVAG (Academy Midwifery Amsterdam and Groningen), Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Corine Verhoeven
- Midwifery Science, AVAG (Academy Midwifery Amsterdam and Groningen), Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, Maxima Medical Centre, Veldhoven, The Netherlands
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Janneke Gitsels
- Midwifery Science, AVAG (Academy Midwifery Amsterdam and Groningen), Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Shakespeare C, Dube H, Moyo S, Ngwenya S. Resilience and vulnerability of maternity services in Zimbabwe: a comparative analysis of the effect of Covid-19 and lockdown control measures on maternal and perinatal outcomes, a single-centre cross-sectional study at Mpilo Central Hospital. BMC Pregnancy Childbirth 2021; 21:416. [PMID: 34088285 PMCID: PMC8177257 DOI: 10.1186/s12884-021-03884-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 05/19/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND On the 27th of March 2020 the Zimbabwean government declared the Covid-19 pandemic a 'national disaster'. Travel restrictions and emergency regulations have had significant impacts on maternity services, including resource stock-outs, and closure of antenatal clinics during the lockdown period. Estimates of the indirect impact of Covid-19 on maternal and perinatal mortality was expected it to be considerable, but little data was yet available. This study aimed to examine the impact of Covid-19 and lockdown control measures on non-Covid outcomes in a government tertiary level maternity unit in Bulawayo, Zimbabwe, by comparing maternal and perinatal morbidity and mortality before, and after the lockdown was implemented. METHODS This was a retrospective, observational study, using a cross-sectional design to compare routine monthly maternal and perinatal statistics three months before and after Covid-19 emergency measures were implemented at Mpilo Central Hospital. RESULTS Between January-March and April-June 2020, the mean monthly deliveries reduced from 747.3 (SD ± 61.3) in the first quarter of 2020 to 681.0 (SD ± 17.6) during lockdown, but this was not statistically significant, p = 0.20. The Caesarean section rates fell from a mean of 29.8% (SD ± 1.7) versus 28.0% (SD ± 1.7), which was also not statistically significant, p = 0.18. During lockdown, the percentage of women delivering at Mpilo Central Hospital who were booked at the hospital fell from a mean of 41.6% (SD ± 1.1) to 35.8% (SD ± 4.3) which was statistically significant, p = 0.03. There was no significant change, however, in maternal mortality or severe maternal morbidity (such as post-partum haemorrhage (PPH), uterine rupture, and severe preeclampsia/eclampsia), stillbirth rate or special care baby unit admission. There was an increase in the mean total number of early neonatal deaths (ENND) (mean 18.7 (SD ± 2.9) versus 24.0 (SD ± 4.6), but this was not statistically significant, p = 0.32. CONCLUSIONS Overall, maternity services at Mpilo showed resilience during the lockdown period, with no significant change in maternal and perinatal adverse outcomes, with the same number of man-hours worked before and during the lockdown Maternal and perinatal outcomes should continue to be monitored to assess the impact of Covid-19 and the lockdown measures as the pandemic in Zimbabwe unfolds. Further studies would be beneficial to explore women's experiences and understand how bookings and deliveries at local clinics changed during this time.
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Affiliation(s)
- Clare Shakespeare
- Department of Obstetrics and Gynaecology, Mpilo Central Hospital, Vera Road, Mzilikazi, Bulawayo, Zimbabwe.
| | - Handsome Dube
- Department of Obstetrics and Gynaecology, Mpilo Central Hospital, Vera Road, Mzilikazi, Bulawayo, Zimbabwe
| | - Sikhangezile Moyo
- Maternity Department Matron, Mpilo Central Hospital, Vera Road, Mzilikazi, Bulawayo, Zimbabwe
| | - Solwayo Ngwenya
- Department of Obstetrics and Gynaecology, Mpilo Central Hospital, Vera Road, Mzilikazi, Bulawayo, Zimbabwe
- National University of Science and Technology, Bulawayo, Zimbabwe
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Mothupi MC, De Man J, Tabana H, Knight L. Development and testing of a composite index to monitor the continuum of maternal health service delivery at provincial and district level in South Africa. PLoS One 2021; 16:e0252182. [PMID: 34033670 PMCID: PMC8148336 DOI: 10.1371/journal.pone.0252182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/11/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The continuum of care is a recommended framework for comprehensive health service delivery for maternal health, and it integrates health system and social determinants of health. There is a current lack of knowledge on a measurement approach to monitor performance on the framework. In this study we aim to develop and test a composite index for assessing the maternal health continuum in a province in South Africa with the possibility of nationwide use. MATERIALS AND METHODS The composite index was computed as a geometric mean of four dimensions of adequacy of the continuum of care. Data was sourced from the district health information system, household surveys and the census. The index formula was tested for robustness when alternative inputs for indicators and standardization methods were used. The index was used to assess performance in service delivery in the North West province of South Africa, as well as its four districts over a five-year period (2013-2017). The index was validated by assessing associations with maternal health and other outcomes. And factor analysis was used to assess the statistical dimensions of the index. RESULTS The provincial level index score increased from 62.3 in 2013 to 74 in 2017, showing general improvement in service delivery over time. The district level scores also improved over time, and our analysis identified areas for performance improvement. These include social determinants of health in some districts, and access and linkages to care in others. The provincial index was correlated with institutional maternal mortality rates (rs = -0.90, 90% CI = (-1.00, -0.25)) and the Human Development Index (r = 0.97, 95% CI = (0.63, 0.99). It was robust to alternative approaches including z-score standardization of indicators. Factor analysis showed three groupings of indicators for the health system and social determinants of health. CONCLUSIONS This study demonstrated the development and testing of a composite index to monitor and assess service delivery on the continuum of care for maternal health. The index was shown to be robust and valid, and identified potential areas for service improvement. A contextualised version can be tested in other settings within and outside of South Africa.
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Affiliation(s)
- Mamothena Carol Mothupi
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Jeroen De Man
- Department of Primary and Interdisciplinary Care, Centre for General Practice, University of Antwerp, Antwerp, Belgium
| | - Hanani Tabana
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Lucia Knight
- School of Public Health & Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Zegeye B, Ahinkorah BO, Ameyaw EK, Seidu AA, Yaya S. Utilization of Deworming Drugs and Its Individual and Community Level Predictors among Pregnant Married Women in Cameroon: A Multilevel Modeling. Biomed Res Int 2021; 2021:6645336. [PMID: 34095307 PMCID: PMC8137305 DOI: 10.1155/2021/6645336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/05/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although deworming pregnant women is one of the strategies to reduce parasites (roundworms and hookworms) causing anemia and related perinatal and maternal complications, utilization of deworming medication among pregnant women in Cameroon is suboptimal. Comprehensive assessment of individual, household (including women's autonomy), and community-level factors associated with utilization of deworming medication has not been done so far. Therefore, we investigated the individual/household and community-level factors associated with deworming among pregnant married women in Cameroon. METHODS Our study was limited to pregnant women because they have a greater risk due to increased chances of anemia. We used data from the 2018/19 Cameroon Demographic and Health Survey. Analysis on 5,013 pregnant married women was carried out using multilevel logistic regression. Odds ratios with a 95% confidence interval (CI) were reported. RESULTS Our findings showed that about 29.8% of pregnant married women received deworming medications. The individual/household level predictors of deworming medications utilization identified in this study were women's educational level, wealth quintile, and skilled antenatal care. Distance to health facility and region were identified as community-level predictors of deworming medications utilization. Higher odds of receiving deworming medication occurred among educated and wealthier pregnant married women as well as among pregnant married women who had skilled antenatal care or lived in the south region, whereas lower odds were observed among pregnant married women living in the north region. CONCLUSION Access to education and economic empowerment of pregnant married women in remote areas and the north region should be the primary focus of the Cameroon government to enhance deworming coverage in the country.
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Affiliation(s)
- Betregiorgis Zegeye
- Shewarobit Field Office, HaSET Maternal and Child Health Research Program, Addis Ababa, Ethiopia
| | | | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Sanni Yaya
- University of Parakou, Faculty of Medicine, Parakou, Benin
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Cardona Cordero NR, Ramos JP, Tavarez ZQ, McIntosh S, Avendaño E, DiMare C, Ossip DJ, De Ver Dye T. Relationship between perceived social support and postpartum care attendance in three Latin American countries: a cross-sectional analytic study. Glob Health Res Policy 2021; 6:16. [PMID: 33958000 PMCID: PMC8103641 DOI: 10.1186/s41256-021-00196-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 03/24/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Postpartum Care is a strategy to improve survival of women and newborns, especially in low- and middle-income countries. Early post-partum care can promote healthy behaviors and the identification of risk factors associated with poorer pregnancy-related outcomes. The objective of this study was to assess the association of perceived social support with attendance to post-partum care in women from three Latin-American and Caribbean countries: Costa Rica, Dominican Republic and Honduras. METHODS Women aged 18+ who completed a pregnancy in the past 5 years were interviewed in local healthcare and community settings in each country. Perceived social support (PSS) was the primary explanatory variable and the primary outcome was self-reported attendance to post-partum care. Odds Ratios (OR) with 95% confidence intervals derived from logistic regression documented the association between variables. Adjusted Odds Ratios (AOR) were calculated, controlling for social and pregnancy-related confounders. Hosmer- Lemeshow's Goodness-of-Fit statistic was computed to assess model fit. RESULTS Our cohort of 1199 women across the three Latin-American and Caribbean countries showed relatively high attendance to post-partum care (82.6%, n = 990). However, 51.7% (n = 581) of women reported lower levels of total PSS. Women were more likely to attend postpartum care if they had mean and higher levels of PSS Family subscale (OR: 1.9, 95%CI: 1.4, 2.7), Friends subscale (OR 1.3, 95%CI: 0.9,1.8), Significant Other subscale (OR 1.8, 95%CI: 1.3, 2.4) and the Total PSS (OR 1.8, 95%CI: 1.3, 2.5). All associations were statistically significant at p < 0.05, with exception of the Friends subscale. Women with higher levels of total PSS were more likely to attend to post-partum care (AOR:1.40, 0.97, 1.92) even after controlling for confounders (education, country, and food insecurity). CONCLUSIONS Women with higher perceived social support levels were more likely to attend to post-partum care. From all countries, women from Dominican Republic had lower perceived social support levels and this may influence attendance at post-partum care for this subgroup. Societal and geographic factors can act as determinants when evaluating perceived social support during pregnancy.
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Affiliation(s)
- Nancy R. Cardona Cordero
- University of Rochester, School of Medicine and Dentistry, Obstetrics and Gynecology Department Research Division, 601 Elmwood Avenue, Rochester, NY 14642 USA
| | - José Perez Ramos
- University of Rochester, School of Medicine and Dentistry, Obstetrics and Gynecology Department Research Division, 601 Elmwood Avenue, Rochester, NY 14642 USA
| | - Zahira Quiñones Tavarez
- Pontificia Universidad Católica Madre y Maestra, Santiago De Los Caballeros, 51000 República Dominicana
| | - Scott McIntosh
- University of Rochester, School of Medicine and Dentistry, Obstetrics and Gynecology Department Research Division, 601 Elmwood Avenue, Rochester, NY 14642 USA
| | - Esteban Avendaño
- Universidad de Ciencias Médicas, 400 metros oeste del M.A.G., Carr. Vieja a Escazú, San José, 10108 Costa Rica
| | - Carmen DiMare
- Universidad de Ciencias Médicas, 400 metros oeste del M.A.G., Carr. Vieja a Escazú, San José, 10108 Costa Rica
| | - Deborah J. Ossip
- University of Rochester, School of Medicine and Dentistry, Obstetrics and Gynecology Department Research Division, 601 Elmwood Avenue, Rochester, NY 14642 USA
| | - Timothy De Ver Dye
- University of Rochester, School of Medicine and Dentistry, Obstetrics and Gynecology Department Research Division, 601 Elmwood Avenue, Rochester, NY 14642 USA
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Ayana A, Kassie A, Azale T. Intention to use institutional delivery service and its predictors among pregnant women, North West Ethiopia: Using theory of planned behavior. PLoS One 2021; 16:e0248697. [PMID: 33961637 PMCID: PMC8104421 DOI: 10.1371/journal.pone.0248697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 03/03/2021] [Indexed: 11/23/2022] Open
Abstract
Background Improving institutional delivery service is the most crucial strategies to reduce maternal and neonatal mortalities. In developing countries, only 50% of pregnant women deliver in health facilities and in Ethiopia only 48% of pregnant women deliver in health facilities. Maternal mortality remains the highest in Ethiopia. This study assessed intention to use institutional delivery service and its predictors among pregnant women using theory of planned behavior. Methods Community-based cross-sectional study was conducted among 645 Yilmana Densa District Pregnant women using multi-stage followed by cluster sampling technique. Data were entered into Epi Data version 4.6.0.2 and analyzed with STATA version 14. Binary logistic regression analysis was done to identify independent predictors of intention at 95% confidence level and P < 0.05 was used to determine statistically significant predictors. Results Intention of pregnant women to use institutional delivery service was 74.3% (CI; 70.71%, 77.6%). In the multivariable logistic regression; those who had 1–3 and 4 &above antenatal care 2.85(1.41, 5.75) and 3.14(1.16, 8.45) respectively, those who had past experience of institutional delivery (AOR = 3.39, 95%CI: 1.72, 6.71), parity of 1–3 and 4 & above % (AOR = 0.37, 0.19, 0.71) and (AOR = 0.25, 95%CI: 0.12, 0.55) respectively, rural residence (AOR = 0.51, 95%CI: 0.27, 0.96), favorable attitude (AOR = 2.93, 95%CI: 1.56, 5.50), favorable perceived behavioral control (AOR = 2.60, 95%CI: 1.44, 4.69) were factors significantly associated with intention to use institutional delivery service. Conclusion and recommendation Majority of the pregnant women were intended to deliver in the institution. Good Knowledge on institutional delivery, antenatal care visit, past experience of institutional delivery, rural residence, parity, attitude and perceived behavioral control were identified factors significantly associated with intention to use institutional delivery service. So, strengthening awareness creation and behavioral change communication programs are required at all levels of health system to raise intention of residents towards institutional delivery.
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Affiliation(s)
- Abirham Ayana
- Amhara Regional State Health Bureau, Bahir Dar, Ethiopia
| | - Ayenew Kassie
- Department of Health Education and Behavioral Sciences, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Telake Azale
- Department of Health Education and Behavioral Sciences, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Patabendige M, Agampodi SB, Jayawardane A, Wickramasooriya DJ, Agampodi TC. Perceptions on respectful maternity care in Sri Lanka: Study protocol for a mixed-methods study of patients and providers. PLoS One 2021; 16:e0250920. [PMID: 33951090 PMCID: PMC8099093 DOI: 10.1371/journal.pone.0250920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 04/13/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Over the past few decades, interest in providing and measuring Respectful Maternity Care (RMC) has increased markedly. Sri Lanka is reportedly shown to have better maternal health statistics and studies on quality improvement are lacking in this unique population. We aim to describe healthcare providers' perceptions and women's expectations, perceptions and their gaps in service provision regarding RMC in Sri Lanka. METHODS A descriptive cross-sectional study with a mixed-methods approach comprising of qualitative component followed by a quantitative component will be conducted in Castle Street Hospital for Women (CSHW) and De Soysa Hospital for Women (DSHW), Colombo, Sri Lanka. Healthcare providers (HCP- doctors, nurses and midwives) and vaginally delivered postnatal women (in postnatal wards and postnatal well-baby clinics) will be recruited through convenience sampling. In-depth interviews will be conducted with each of the four categories. Thematic analysis will be adopted to analyze qualitative data and the findings will further be used to improve the quantitative phase questionnaires. Self-administered questionnaire will be administered to a 378 vaginally delivered postnatal women [quota sampling across ten wards], exploring demographic details, and maternal opinion on various aspects of RMC. Locally validated Women's Perceptions of RMC tool (WP-RMC) will also be used to measure the level of RMC among these postnatal women along with the questionnaire 01. Qualitative findings will be used for cognitive validation of the WP-RMC into the Sri Lankan setting. DISCUSSION This study will explore HCP's and women's expectations, perceptions and their gaps in service provision regarding RMC in two maternity hospitals in Sri Lanka. Assessment of the quality of care with regards to RMC have not been reported previously in this setting.
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Affiliation(s)
- Malitha Patabendige
- Obstetrics and Gynaecology Wards- 07 and 08, Castle Street Hospital for Women, Colombo, Sri Lanka
| | - Suneth Buddhika Agampodi
- Faculty of Medicine and Allied Sciences, Department of Community Medicine, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | - Asanka Jayawardane
- Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Colombo, Colombo, Sri Lanka
| | | | - Thilini Chanchala Agampodi
- Faculty of Medicine and Allied Sciences, Department of Community Medicine, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
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Brar AS, Hedt-Gauthier BL, Hirschhorn LR. Mixed Methods Lot Quality Assurance Sampling: A novel, rapid methodology to inform equity focused maternal health programming in rural Rajasthan, India. PLoS One 2021; 16:e0250154. [PMID: 33914763 PMCID: PMC8084134 DOI: 10.1371/journal.pone.0250154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 03/31/2021] [Indexed: 11/18/2022] Open
Abstract
India has experienced a significant increase in facility-based delivery (FBD) coverage and reduction in maternal mortality. Nevertheless, India continues to have high levels of maternal health inequity. Improving equity requires data collection methods that can produce a better contextual understanding of how vulnerable populations access and interact with the health care system at a local level. While large population-level surveys are valuable, they are resource intensive and often lack the contextual specificity and timeliness to be useful for local health programming. Qualitative methods can be resource intensive and may lack generalizability. We describe an innovative mixed-methods application of Large Country-Lot Quality Assurance Sampling (LC-LQAS) that provides local coverage data and qualitative insights for both FBD and antenatal care (ANC) in a low-cost and timely manner that is useful for health care providers working in specific contexts. LC-LQAS is a version of LQAS that combines LQAS for local level classification with multistage cluster sampling to obtain precise regional or national coverage estimates. We integrated qualitative questions to uncover mothers' experiences accessing maternal health care in the rural district of Sri Ganganagar, Rajasthan, India. We interviewed 313 recently delivered, low-income women in 18 subdistricts. All respondents participated in both qualitative and quantitative components. All subdistricts were classified as having high FBD coverage with the upper threshold set at 85%, suggesting that improved coverage has extended to vulnerable women. However, only two subdistricts were classified as high ANC coverage with the upper threshold set at 40%. Qualitative data revealed a severe lack of agency among respondents and that household norms of care seeking influenced uptake of ANC and FBD. We additionally report on implementation outcomes (acceptability, feasibility, appropriateness, effectiveness, fidelity, and cost) and how study results informed the programs of a local health non-profit.
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Affiliation(s)
- Aneel Singh Brar
- Mata Jai Kaur Maternal and Child Health Centre, Sri Ganganagar, Rajasthan, India
- School of Anthropology and Museum Ethnography, University of Oxford, Oxford, Oxfordshire, United Kingdom
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Bethany L. Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Biostatistics, Harvard Chan School, Boston, Massachusetts, United States of America
| | - Lisa R. Hirschhorn
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
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Giblin L, Vousden N, Nathan H, Gidiri F, Goudar S, Charantimath U, Sandall J, Seed PT, Chappell LC, Shennan AH. Effect of the CRADLE vital signs alert device intervention on referrals for obstetric haemorrhage in low-middle income countries: a secondary analysis of a stepped- wedge cluster-randomised control trial. BMC Pregnancy Childbirth 2021; 21:317. [PMID: 33882864 PMCID: PMC8061003 DOI: 10.1186/s12884-021-03796-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/16/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Obstetric haemorrhage is the leading cause of maternal death worldwide, 99% of which occur in low and middle income countries. The majority of deaths and adverse events are associated with delays in identifying compromise and escalating care. Management of severely compromised pregnant women may require transfer to tertiary centres for specialised treatment, therefore early recognition is vital for efficient management. The CRADLE vital signs alert device accurately measures blood pressure and heart rate, calculates the shock index (heart rate divided by systolic blood pressure) and alerts the user to compromise through a traffic light system reflecting previously validated shock index thresholds. METHODS This is a planned secondary analysis of data from the CRADLE-3 trial from ten clusters across Africa, India and Haiti where the device and training package were randomly introduced. Referral data were prospectively collected for a 4-week period before, and a 4-week period 3 months after implementation. Referrals from primary or secondary care facilities to higher level care for any cause were recorded. The denominator was the number of women seen for maternity care in these facilities. RESULTS Between April 1 2016 and Nov 30th, 2017 536,223 women attended maternity care facilities. Overall, 3.7% (n = 2784/74,828) of women seen in peripheral maternity facilities were referred to higher level care in the control period compared to 4.4% (n = 3212/73,371) in the intervention period (OR 0.89; 0.39-2.05) (data for nine sites that were able to collect denominator). Of these 0.29% (n = 212) pre-intervention and 0.16% (n = 120) post-intervention were referred to higher-level facilities for maternal haemorrhage. Although overall referrals did not significantly reduce there was a significant reduction in referrals for obstetric haemorrhage (OR 0.56 (0.39-0.65) following introduction of the device with homogeneity (i-squared 26.1) between sites. There was no increase in any bleeding-related morbidity (maternal death or emergency hysterectomy). CONCLUSIONS Referrals for obstetric haemorrhage reduced following implementation of the CRADLE Vital Signs Alert Device, occurring without an increase in maternal death or emergency hysterectomy. This demonstrates the potential benefit of shock index in management pathways for obstetric haemorrhage and targeting limited resources in low- middle- income settings. TRIAL REGISTRATION This study is registered with the ISRCTN registry, number ISRCTN41244132 (02/02/2016).
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Affiliation(s)
- Lucie Giblin
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, SE1 7EH, UK
| | - Nicola Vousden
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, SE1 7EH, UK
| | - Hannah Nathan
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, SE1 7EH, UK
| | - Francis Gidiri
- Department of Obstetrics and Gynaecology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Shivaprasad Goudar
- Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Umesh Charantimath
- Women's and Children's Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Jane Sandall
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, SE1 7EH, UK
| | - Paul T Seed
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, SE1 7EH, UK
| | - Lucy C Chappell
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, SE1 7EH, UK
| | - Andrew H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, SE1 7EH, UK.
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Aninanya GA, Otupiri E, Howard N. Effects of combined decision-support and performance-based incentives on reported client satisfaction with maternal health services in primary facilities: A quasi-experimental study in the Upper East Region of Ghana. PLoS One 2021; 16:e0249778. [PMID: 33878127 PMCID: PMC8057590 DOI: 10.1371/journal.pone.0249778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 03/24/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Computerized decision-support systems (CDSS) and performance-based incentives (PBIs) have potential to contribute to client satisfaction with health services. However, rigorous evidence is lacking on the effectiveness of these strategies in lower-income countries such as Ghana. This study aimed to determine the effect of a combined CDSS-PBI intervention on client satisfaction with maternal health services in primary facilities in the Upper East Region of Ghana. METHODS We employed a quasi-experimental controlled baseline and endline design to assess the effect of the combined interventions on client satisfaction with maternal health services, measured by quantitative pre/post-test client satisfaction survey. Our analysis used difference-in-difference logistic regression, controlling for potential covariates, to compare variables across intervention and comparison facilities at baseline and endline. RESULTS The combined CDSS-PBI intervention was associated with increased or unchanged client satisfaction with all maternal health services compared at endline. Antenatal client difference-in-difference of mean satisfaction scores were significant at endline for intervention (n = 378) and comparison (n = 362) healthcare facilities for overall satisfaction (DiD 0.058, p = 0.014), perception of providers' technical performance (DiD = 0.142; p = 0.006), client-provider interaction (DiD = 0.152; p = 0.001), and provider availability (DiD = 0.173; p = 0.001). Delivery client difference-in-difference of satisfaction scores were significant at endline for intervention (n = 318) and comparison (n = 240) healthcare facilities for overall satisfaction with delivery services (DiD = 0.072; p = 0.02) and client-provider interaction (DiD = 0.146; p = 0.02). However, mean overall satisfaction actually reduced slightly in intervention facilities, while DiD for technical performance and provider availability were not significant. CONCLUSION This combined CDSS-PBI intervention was associated with greater antenatal and delivery client satisfaction with some aspects of maternity services within two years of implementation. It could be expanded elsewhere if funds allow, though further research is still required to assess cost-effectiveness and long-term effects on client satisfaction and maternal health outcomes.
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Affiliation(s)
- Gifty Apiung Aninanya
- Department of Health Services Policy, Planning, Management and Economics, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Easmon Otupiri
- College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Natasha Howard
- National University of Singapore, Saw Swee Hock School of Public Health, Singapore, Singapore
- London School of Hygiene and Tropical Medicine, Department of Global Health and Development, London, United Kingdom
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Rishard M, Fahmy FF, Senanayake H, Ranaweera AKP, Armocida B, Mariani I, Lazzerini M. Correlation among experience of person-centered maternity care, provision of care and women's satisfaction: Cross sectional study in Colombo, Sri Lanka. PLoS One 2021; 16:e0249265. [PMID: 33831036 PMCID: PMC8031099 DOI: 10.1371/journal.pone.0249265] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 03/15/2021] [Indexed: 11/19/2022] Open
Abstract
Person-centered maternity care (PCMC) is defined as care which is respectful of and responsive to women's and families' preferences, needs, and values. In this cross-sectional study we aimed to evaluate the correlations among the degree of PCMC implementation, key indicators of provision of care, and women's satisfaction with maternity care in Sri Lanka. Degree of PCMC implementation was assessed using a validated questionnaire. Provision of good key practices was measured with the World Health Organization (WHO) Bologna Score, whose items include: 1) companionship in childbirth; 2) use of partogram; 3) absence of labor stimulation; 4) childbirth in non-supine position; 5) skin-to-skin contact. Women's overall satisfaction was assessed on a 1-10 Likert scale. Among 400 women giving birth vaginally, 207 (51.8%) had at least one clinical risk factor and 52 (13.0%) at least one complication. The PCMC implementation mean score was 42.3 (95%CI 41.3-43.4), out of a maximum score of 90. Overall, while 367 (91.8%) women were monitored with a partogram, and 293 (73.3%) delivered non-supine, only 19 (4.8%) did not receive labour stimulation, only 38 (9.5%) had a companion at childbirth, and 165 (41.3%) had skin-to-skin contact immediately after birth. The median total satisfaction score was 7 (IQR 5-9). PCMC implementation had a moderate correlation with women's satisfaction (r = 0.58), while Bologna score had a very low correlation both with satisfaction (r = 0.12), and PCMC (r = 0.20). Factors significantly associated with higher PCMC score were number of pregnancies (p = 0.015), ethnicity (p<0.001), presence of a companion at childbirth (p = 0.037); absence of labor stimulation (p = 0.019); delivery in non-supine position (p = 0.016); and skin-to-skin contact (p = 0.005). Study findings indicate evidence of poor-quality care across several domains of mistreatment in childbirth in Sri Lanka. In addition, patient satisfaction as an indicator of quality care is inadequate to inform health systems reform.
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Affiliation(s)
- Mohamed Rishard
- University Obstetrics Unit, De Soysa Hospital for Women, Colombo, Sri Lanka
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- * E-mail:
| | - Fathima Fahila Fahmy
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Hemantha Senanayake
- University Obstetrics Unit, De Soysa Hospital for Women, Colombo, Sri Lanka
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | - Benedetta Armocida
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”—Trieste, Italy
| | - Ilaria Mariani
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”—Trieste, Italy
| | - Marzia Lazzerini
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”—Trieste, Italy
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Ayele B, Woldu M, Gebrehiwot H, Wellay T, Hadgu T, Gebretnsae H, Abrha A, Gebre-egziabher E, Hurlburt S. Do mothers who delivered at health facilities return to health facilities for postnatal care follow-up? A multilevel analysis of the 2016 Ethiopian Demographic and Health Survey. PLoS One 2021; 16:e0249793. [PMID: 33826670 PMCID: PMC8026072 DOI: 10.1371/journal.pone.0249793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 03/24/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Returning to health facility for postnatal care (PNC) use after giving birth at health facility could reflect the health seeking behavior of mothers. However, such studies are rare though they are critically important to develop vigorous strategies to improve PNC service utilization. Therefore, this study aimed to determine the magnitude and factors associated with returning to health facilities for PNC among mothers who delivered in Ethiopian health facilities after they were discharged. Methods This cross-sectional study used 2016 Ethiopian Demographic and Health Survey data. A total of 2405mothers who gave birth in a health facility were included in this study. Multilevel mixed-effect logistic regression model was fitted to estimate both independent (fixed) effects of the explanatory variables and community-level (random) effects on return for PNC utilization. Variable with p-value of ≤ 0.25 from unadjusted multilevel logistic regression were selected to develop three models and p-value of ≤0.05 was used to declare significance of the explanatory variables on the outcome variable in the final (adjusted) model. Analysis was done using IBM SPSS statistics version 21. Result In this analysis, from the total 2405 participants, 14.3% ((95%CI: 12.1–16.8), (n = 344)) of them returned to health facilities for PNC use after they gave birth at a health facility. From the multilevel logistic regression analysis, being employed (AOR = 1.51, 95%CI: 1.04–2.19), receiving eight and above antenatal care visits (AOR = 2.90, 95%CI: 1.05–8.00), caesarean section delivery (AOR = 2.53, 95%CI: 1.40–4.58) and rural residence (AOR = 0.56, 95%CI: 0.36–0.88) were found significantly associated with return to health facilities for PNC use among women who gave birth at health facility. Conclusion Facility-based PNC utilization among mothers who delivered at health facilities is low in Ethiopia. Both individual and community level variables were determined women to return to health facilities for PNC use. Thus, adopting context-specific strategies/policies could improve PNC utilization and should be paid a due focus.
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Affiliation(s)
- Brhane Ayele
- Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
- * E-mail:
| | - Mulugeta Woldu
- Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | | | - Tsegay Wellay
- College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Tsegay Hadgu
- Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | | | - Alemnesh Abrha
- Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | | | - Sarah Hurlburt
- Fenot, a Project of the Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia
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Fakhraei R, Crowcroft N, Bolotin S, Sucha E, Hawken S, Wilson K, Gaudet L, Amirthalingam G, Biringer A, Cook J, Dubey V, Halperin SA, Jamieson F, Kwong JC, Sadarangani M, Walker MC, Laverty M, Fell DB. Obstetric and perinatal health outcomes after pertussis vaccination during pregnancy in Ontario, Canada: a retrospective cohort study. CMAJ Open 2021; 9:E349. [PMID: 33849984 PMCID: PMC8084546 DOI: 10.9778/cmajo.20200239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In February 2018, Canada's National Advisory Committee on Immunization recommended maternal vaccination with tetanus-diphtheria-acellular pertussis (Tdap) vaccine during pregnancy to prevent severe pertussis infection in young infants. This study assessed the relation between maternal Tdap vaccination and obstetric and perinatal outcomes in Ontario. METHODS We performed a population-based cohort study of all births from April 2012 to March 2017 using multiple linked health administrative databases. We used Cox regression with a time-dependent exposure variable to estimate adjusted hazard ratios (HRs) for preterm birth (< 37 wk), very preterm birth (< 32 wk) and stillbirth. We assessed remaining outcomes (gestational hypertension, chorioamnionitis, postpartum hemorrhage, severe postpartum hemorrhage, being small for gestational age, neonatal intensive care unit stay > 24 h, composite neonatal morbidity) using log-binomial regression to generate adjusted risk ratios (RRs). We adjusted estimates for potential confounding using propensity score weighting. RESULTS Of 615 213 infants (live births and stillbirths), 11 519 were exposed to Tdap vaccination in utero. There was no increased risk for preterm birth (adjusted HR 0.98, 95% confidence interval [CI] 0.91-1.06), very preterm birth (adjusted HR 1.10, 95% CI 0.86-1.41), stillbirth (adjusted HR 1.15, 95% CI 0.82-1.60) or being small for gestational age (adjusted RR 0.96, 95% CI 0.90-1.02). The risks of a neonatal intensive care unit stay exceeding 24 hours (adjusted RR 0.82, 95% CI 0.76-0.88) and neonatal morbidity (adjusted RR 0.81, 95% CI 0.75-0.87) were decreased. There was no association with chorioamnionitis (adjusted RR 1.17, 95% CI 0.99-1.39), postpartum hemorrhage (adjusted RR 1.01, 95% CI 0.91-1.13) or severe postpartum hemorrhage (adjusted RR 0.79, 95% CI 0.55-1.13), but we observed a reduced risk of gestational hypertension (adjusted RR 0.87, 95% CI 0.78-0.96). INTERPRETATION Our results complement evidence that maternal Tdap vaccination is not associated with adverse outcomes in mothers or infants. Ongoing evaluation in Canada is needed as maternal Tdap vaccination coverage increases in coming years.
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Affiliation(s)
- Romina Fakhraei
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Natasha Crowcroft
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Shelly Bolotin
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Ewa Sucha
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Steven Hawken
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Kumanan Wilson
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Laura Gaudet
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Gayatri Amirthalingam
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Anne Biringer
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Jocelynn Cook
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Vinita Dubey
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Scott A Halperin
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Frances Jamieson
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Jeffrey C Kwong
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Manish Sadarangani
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Mark C Walker
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Meghan Laverty
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Deshayne B Fell
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
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Temesgen K, Wakgari N, Debelo BT, Tafa B, Alemu G, Wondimu F, Gudisa T, Gishile T, Daba G, Bulto GA, Soboka B. Maternal health care services utilization amidstCOVID-19 pandemic in West Shoa zone, central Ethiopia. PLoS One 2021; 16:e0249214. [PMID: 33770120 PMCID: PMC7997037 DOI: 10.1371/journal.pone.0249214] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/12/2021] [Indexed: 12/14/2022] Open
Abstract
The novel coronavirus (COVID-19) is an infectious disease caused by a newly discovered coronavirus. Despite strong efforts that have been taking place to control the pandemic globally, the virus is on the rise in many countries. Hence, this study assessed the maternal health care services utilization amidst the COVID-19 pandemic in West Shoa zone, Central Ethiopia. A community-based cross-sectional study was conducted among 844 pregnant women or those who gave birth in the last 6 months before the study. A multi-stage sampling technique was used to select the study participants. The data were collected through face-to-face interviews using a semi-structured questionnaire. Logistic regressions were performed to identify the presence of significant associations, and an adjusted odds ratio with 95%CI was employed for the strength and directions of association between the independent and outcome variables. A P-value of <0.05 was used to declare statistical significance. The prevalence of maternal health service utilization during the COVID-19 pandemic was 64.8%. The odds of maternal health service utilization was higher among mothers who had primary (AOR = 2.16, 95%CI: 1.29-3.60), secondary (AOR = 1.97, 95%CI: 1.13-3.44), and college and above education (AOR = 2.89, 95%CI: 1.34-6.22) than those who could not read and write. Besides, mothers who did travel 30-60 minutes (AOR = 0.37, 95%CI: 0.23-0.59) and 60-90minutes (AOR = 0.10, 95%CI: 0.05-0.19) to reach the health facility had a lower odds of maternal health service utilization than those who did travel <30 minutes. Moreover, mothers who earn 1000-2000 (AOR = 3.10, 95%CI: 1.73-5.55) and > 2000 birrs (AOR = 2.66 95%CI: 1.52-4.64) had higher odds of maternal health service utilization than those who earn <500 birrs. Similarly, the odds of utilizing maternal health service were higher among mothers who did not fear COVID-19 infection (AOR = 2.79, 95%CI: 1.85-4.20), who had not had to request permission from husband to visit the health facility (AOR = 7.24, 95%CI: 2.65-19.75), who had practicedCOVID-19 prevention measure (AOR = 5.82, 95%CI: 3.87-8.75), and used face mask (AOR = 2.06, 95% CI: 1.28-3.31) than their counterpart. Empowering mothers and creating awareness on COVID-19 preventionis recommended to improve maternal health service utilization during the COVID-19 pandemic.
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Affiliation(s)
- Kababa Temesgen
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Negash Wakgari
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Bikila Tefera Debelo
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Belay Tafa
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Getu Alemu
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Fikadu Wondimu
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Tolera Gudisa
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Tolosa Gishile
- Department of Obstetrics and Gynecology, Ambo University Referral Hospital, Ambo, Ethiopia
| | - Gurmesa Daba
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Gizachew Abdissa Bulto
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Bikila Soboka
- Ethiopian Public Health Institute, Health System and Reproductive Health Research, Addis Ababa, Ethiopia
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Bradfield Z, Wynter K, Hauck Y, Vasilevski V, Kuliukas L, Wilson AN, Szabo RA, Homer CSE, Sweet L. Experiences of receiving and providing maternity care during the COVID-19 pandemic in Australia: A five-cohort cross-sectional comparison. PLoS One 2021; 16:e0248488. [PMID: 33760851 PMCID: PMC7990294 DOI: 10.1371/journal.pone.0248488] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 03/01/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction The global COVID-19 pandemic has radically changed the way health care is delivered in many countries around the world. Evidence on the experience of those receiving or providing maternity care is important to guide practice through this challenging time. Methods A cross-sectional study was conducted in Australia. Five key stakeholder cohorts were included to explore and compare the experiences of those receiving or providing care during the COVID-19 pandemic. Women, their partners, midwives, medical practitioners and midwifery students who had received or provided maternity care from March 2020 onwards in Australia were recruited via social media and invited to participate in an online survey released between 13th May and 24th June 2020; a total of 3701 completed responses were received. Findings While anxiety related to COVID-19 was high among all five cohorts, there were statistically significant differences between the responses from each cohort for most survey items. Women were more likely to indicate concern about their own and family’s health and safety in relation to COVID-19 whereas midwives, doctors and midwifery students were more likely to be concerned about occupational exposure to COVID-19 through working in a health setting than those receiving care through attending these environments. Midwifery students and women’s partners were more likely to respond that they felt isolated because of the changes to the way care was provided. Despite concerns about care received or provided not meeting expectations, most respondents were satisfied with the quality of care provided, although midwives and midwifery students were less likely to agree. Conclusion This paper provides a unique exploration and comparison of experiences of receiving and providing maternity care during the COVID-19 pandemic in Australia. Findings are useful to support further service changes and future service redesign. New evidence provided offers unique insight into key stakeholders’ experiences of the rapid changes to health services.
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Affiliation(s)
- Zoe Bradfield
- School of Nursing, Midwifery and Paramedicine, Curtin University, Western Australia, Australia
- Department of Nursing, Midwifery Education and Research, King Edward Memorial Hospital, Western Australia, Australia
- * E-mail:
| | - Karen Wynter
- School of Nursing and Midwifery, Deakin University, Victoria, Australia
- Centre for Quality and Patient Safety Research, Western Health Partnership, Victoria, Australia
| | - Yvonne Hauck
- School of Nursing, Midwifery and Paramedicine, Curtin University, Western Australia, Australia
- Department of Nursing, Midwifery Education and Research, King Edward Memorial Hospital, Western Australia, Australia
| | - Vidanka Vasilevski
- School of Nursing and Midwifery, Deakin University, Victoria, Australia
- Centre for Quality and Patient Safety Research, Western Health Partnership, Victoria, Australia
| | - Lesley Kuliukas
- School of Nursing, Midwifery and Paramedicine, Curtin University, Western Australia, Australia
| | - Alyce N. Wilson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Victoria, Australia
| | - Rebecca A. Szabo
- Department of Medical Education and Department of Obstetrics and Gynaecology, The University of Melbourne, Victoria, Australia
| | - Caroline S. E. Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Victoria, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Deakin University, Victoria, Australia
- Centre for Quality and Patient Safety Research, Western Health Partnership, Victoria, Australia
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Wang Q, Mo PKH, Song B, Di JL, Zhou FR, Zhao J, Wu YL, Tian H, Qiu LQ, Xia J, Wang L, Li F, Wang LH. Mental health and preventive behaviour of pregnant women in China during the early phase of the COVID-19 period. Infect Dis Poverty 2021; 10:37. [PMID: 33761984 PMCID: PMC7988630 DOI: 10.1186/s40249-021-00825-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/12/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The COVID-19 has caused significant toll over the globe. Pregnant women are at risk of infection. The present study examined the frequency of washing hands with soap and wearing face mask when going out, prevalence of depression and anxiety, and identified their associated factors among pregnant women during the early phase of COVID-19 outbreak in China. METHODS A cross-sectional online survey was conducted between 24 February and 3 March 2020. A total of 15 428 pregnant women who were using maternal health care services in China completed a questionnaire which assessed their socio-demographic and pregnancy-related characteristics, contextual, cognitive and social factors related to COVID-19, frequency of washing hands and wearing face masks, and depression and anxiety. Logistics regression analyses were performed to identify the associated factors of preventive behaviours and mental health. RESULTS The prevalence of probable anxiety and depression was 28.2% and 43.6% respectively. 19.8% reported always wearing face mask when going out, and 19.1% reported washing hands with soap for more than 10 times per day. Results from logistic regression analyses showed that older age was associated with lower levels of depression and anxiety (OR = 0.42-0.67) and higher frequency of washing hands (OR = 1.57-3.40). Higher level of education level was associated with probable depression (OR = 1.31-1.45) and higher frequency of wearing face mask (OR = 1.50-1.57). After adjusting for significant socio-demographic and pregnancy-related factors, place of residence being locked down (aOR = 1.10-1.11), being quarantined (aOR = 1.42-1.57), personally knowing someone being infected with COVID-19 (aOR = 1.80-1.92), perception that COVID-19 would pose long term physical harm to human (aOR = 1.25-1.28) were associated with higher levels of depression and anxiety, while the perception that the disease will be under control in the coming month was associated with lower levels of depression and anxiety (aOR = 0.59-0.63) and lower tendency of always wearing face mask (aOR = 0.85). Social support was associated with lower levels of depression and anxiety (aOR = 0.86-0,87) and higher frequency of washing hands (aOR = 1.06). CONCLUSIONS The mental health and preventive behaviours of pregnant women during COVID-19 outbreak was associated with a range of socio-demographic, pregnancy-related, contextual, cognitive and social factors. Interventions to mitigate their mental health problems and to promote preventive behaviours are highly warranted.
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Affiliation(s)
- Qian Wang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Phoenix K H Mo
- Center for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Bo Song
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiang-Li Di
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Feng-Rong Zhou
- Shandong Province Hospital for Women and Children's Health, Jinan, China
| | - Juan Zhao
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Ying-Lan Wu
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Hong Tian
- Women and Children's Health Care Hospital of Liaoning Province, Shenyang, China
| | - Li-Qian Qiu
- School of Medicine, Women's Hospital, Zhejiang University, Hangzhou, China
| | - Jianhong Xia
- Guangdong Women and Children Hospital, Guangzhou, China
| | - Lan Wang
- Chong Qing Health Center for Women and Children, Chong Qing, China
| | - Fen Li
- First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, China
| | - Lin-Hong Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 13# Rd Nanwei, Xicheng, Beijing, China.
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Ansu-Mensah M, Danquah FI, Bawontuo V, Ansu-Mensah P, Mohammed T, Udoh RH, Kuupiel D. Quality of care in the free maternal healthcare era in sub-Saharan Africa: a scoping review of providers' and managers' perceptions. BMC Pregnancy Childbirth 2021; 21:220. [PMID: 33740908 PMCID: PMC7977170 DOI: 10.1186/s12884-021-03701-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 03/05/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Free maternal healthcare financing schemes play an essential role in the quality of services rendered to clients during antenatal care in sub-Saharan Africa (SSA). However, healthcare managers' and providers' perceptions of the healthcare financing scheme may influence the quality of care. This scoping review mapped evidence on managers' and providers' perspectives of free maternal healthcare and the quality of care in SSA. METHODS We used Askey and O'Malley's framework as a guide to conduct this review. To address the research question, we searched PubMed, CINAHL through EBSCOhost, ScienceDirect, Web of Science, and Google Scholar with no date limitation to May 2019 using keywords, Boolean terms, and Medical Subject Heading terms to retrieve relevant articles. Both abstract and full articles screening were conducted independently by two reviewers using the inclusion and exclusion criteria as a guide. All significant data were extracted, organized into themes, and a summary of the findings reported narratively. RESULTS In all, 15 out of 390 articles met the inclusion criteria. These 15 studies were conducted in nine countries. That is, Ghana (4), Kenya (3), and Nigeria (2), Burkina Faso (1), Burundi (1), Niger (1), Sierra Leone (1), Tanzania (1), and Uganda (1). Of the 15 included studies, 14 reported poor quality of maternal healthcare from managers' and providers' perspectives. Factors contributing to the perception of poor maternal healthcare included: late reimbursement of funds, heavy workload of providers, lack of essential drugs and stock-out of medical supplies, lack of policy definition, out-of-pocket payment, and inequitable distribution of staff. CONCLUSION This study established evidence of existing literature on the quality of care based on healthcare providers' and managers' perspectives though very limited. This study indicates healthcare providers and managers perceive the quality of maternal healthcare under the free financing policy as poor. Nonetheless, the free maternal care policy is very much needed towards achieving universal health, and all efforts to sustain and improve the quality of care under it must be encouraged. Therefore, more research is needed to better understand the impact of their perceived poor quality of care on maternal health outcomes.
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Affiliation(s)
- Monica Ansu-Mensah
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
- The University Clinic, Sunyani Technical University, Sunyani, Ghana
| | - Frederick Inkum Danquah
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Vitalis Bawontuo
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
- Department of Global Health, Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, 7530 South Africa
| | - Peter Ansu-Mensah
- Department of Secretaryship and Management Studies, Sunyani Technical University, Sunyani, Ghana
| | - Tahiru Mohammed
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Roseline H. Udoh
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Desmond Kuupiel
- Department of Global Health, Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, 7530 South Africa
- Research for Sustainable Development Consult, Sunyani, Ghana
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Amu H, Seidu AA, Agbaglo E, Dowou RK, Ameyaw EK, Ahinkorah BO, Kissah-Korsah K. Mixed effects analysis of factors associated with health insurance coverage among women in sub-Saharan Africa. PLoS One 2021; 16:e0248411. [PMID: 33739985 PMCID: PMC7978354 DOI: 10.1371/journal.pone.0248411] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 02/25/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION In the pursuit of achieving the Sustainable Development Goal targets of universal health coverage and reducing maternal mortality, many countries in sub-Saharan Africa have implemented health insurance policies over the last two decades. Given that there is a paucity of empirical literature at the sub-regional level, we examined the prevalence and factors associated with health insurance coverage among women in in sub-Saharan Africa. MATERIALS AND METHODS We analysed cross-sectional data of 307,611 reproductive-aged women from the most recent demographic and health surveys of 24 sub-Saharan African countries. Bivariable and multivariable analyses were performed using chi-square test of independence and multi-level logistic regression respectively. Results are presented as adjusted Odds Ratios (aOR) for the multilevel logistic regression analysis. Statistical significance was set at p<0.05. RESULTS The overall coverage of health insurance was 8.5%, with cross-country variations. The lowest coverage was recorded in Chad (0.9%) and the highest in Ghana (62.4%). Individual-level factors significantly associated with health insurance coverage included age, place of residence, level of formal education, frequency of reading newspaper/magazine and watching television. Wealth status and place of residence were the contextual factors significantly associated with health insurance coverage. Women with no formal education were 78% less likely to be covered by health insurance (aOR = 0.22, 95% CI = 0.21-0.24), compared with those who had higher education. Urban women, however, had higher odds of being covered by health insurance, compared with those in the rural areas [aOR = 1.20, 95%CI = 1.15-1.25]. CONCLUSION We found an overall relatively low prevalence of health insurance coverage among women of reproductive age in sub-Saharan Africa. As sub-Saharan African countries work toward achieving the Sustainable Development Goal targets of universal health coverage and lowering maternal mortality to less than 70 deaths per 100,000 live births, it is important that countries with low coverage of health insurance among women of reproductive age integrate measures such as free maternal healthcare into their respective development plans. Interventions aimed at expanding health insurance coverage should be directed at younger women of reproductive age, rural women, and women who do not read newspapers/magazines or watch television.
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Affiliation(s)
- Hubert Amu
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Robert Kokou Dowou
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Kwaku Kissah-Korsah
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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Mishra PS, Veerapandian K, Choudhary PK. Impact of socio-economic inequity in access to maternal health benefits in India: Evidence from Janani Suraksha Yojana using NFHS data. PLoS One 2021; 16:e0247935. [PMID: 33705451 PMCID: PMC7951864 DOI: 10.1371/journal.pone.0247935] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 02/16/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Caste plays a significant role in Indian society and it influences women to health care access in the community. The implementation of the maternal health benefits scheme in India is biased due to caste identity. In this context, the paper investigates access to Janani Suraksha Yojana (JSY) among social groups to establish that caste still plays a pivotal role in Indian society. Also, this paper aims to quantify the discrimination against Scheduled Castes/Scheduled Tribes (SCs/STs) in accessing JSY. METHODS This paper uses a national-level data set of both NFHS-3 (2005-06) and NFHS-4 (2015-16). Both descriptive statistics and the Fairlie decomposition econometric model have been used to measure the explained and unexplained differences in access to JSY between SCs/STs and non-SCs/STs groups. RESULTS Overall, the total coverage of JSY in India is still, 36.4%. Further, it is found that 72% of access to JSY is explained by endowment variables. The remaining unexplained percentage (28%) indicates that there is caste discrimination (inequity associated social-discrimination) against SCs/STs in access to JSY. The highest difference (54%) between SCs/STs and non-SCs/STs in access to JSY comes from the wealth quintile, with the positive sign indicating that the gap between the two social groups is widening. DISCUSSION AND CONCLUSION It is necessary for the government to implement a better way to counter the caste-based discrimination in access to maternal health benefits scheme. In this regard, ASHA and Anganwadi workers must be trained to reduce the influence of dominant caste groups as well as they must be recruited from the same community to identify the right beneficiaries of JSY and in order to reduce inequity associated with social-discrimination.
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Affiliation(s)
- Prem Shankar Mishra
- PhD Research Scholar, Population Research Centre, Institute for Social and Economic Change, Bengaluru, Karnataka, India
| | - Karthick Veerapandian
- PhD Research Scholar, Center for Economic Studies and Policy, Institute for Social and Economic Change, Bengaluru, Karnataka, India
| | - Prashant Kumar Choudhary
- PhD Research Scholar, Centre for Political Institutions, Governance and Development, Institute for Social and Economic Change, Bengaluru, Karnataka, India
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Segura-Pérez S, Hromi-Fiedler A, Adnew M, Nyhan K, Pérez-Escamilla R. Impact of breastfeeding interventions among United States minority women on breastfeeding outcomes: a systematic review. Int J Equity Health 2021; 20:72. [PMID: 33676506 PMCID: PMC7936442 DOI: 10.1186/s12939-021-01388-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/18/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In the U.S., strong ethnic/racial, socioeconomic, demographic, and geographic breastfeeding (BF) inequities persist, and African American and Hispanic women are less likely to meet their breastfeeding goals compared to White women. This systematic review (SR) was designed to answer the question: What is the impact of breastfeeding interventions targeting ethnic/racial minority women in the U.S. on improving BF initiation, duration and exclusivity rates? METHODS The SR was conducted following the Institute of Medicine Guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The study protocol was developed and registered a priori in PROSPERO (ID#CRD42020177764). The electronical databases searched was MEDLINE All (Ovid). Search strategies were led by the team's expert public health librarian using both controlled vocabulary and free text queries and were tested against a validated set of relevant papers included in existing reviews. The GRADE methodology was used to assess the quality of the studies. RESULTS We included 60 studies that had randomized (n = 25), observational (n = 24), quasi-experimental (n = 9), or cross-sectional (n = 2) designs. The studies focused on populations that were multi-ethnic/racial (n = 22), only Hispanic (n = 24), only Black (n = 13), and only American Indian (n = 1). The study interventions were classified following the socioecological model: macrosystem/policy level (n = 6); community level (n=51), which included healthcare organizations (n = 34), The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (n = 9), and community organizations/public health institutions (n = 8); and interpersonal level (n = 3). CONCLUSIONS Policy and community level interventions delivered through WIC, healthcare facilities, and community agencies) are likely to improve BF outcomes among women of color. The combination of interventions at different levels of the socioecological model has not been studied among minority women in the U.S. Implementation science research is needed to learn how best to scale up and sustain effective BF interventions, taking into account the needs and wants of minority women. Thus, it is strongly recommended to conduct large scale implementation research studies addressesing how to strengthen the different health and social environments surrounding women of color in the U.S. to improving their BF outcomes.
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Affiliation(s)
| | | | - Misikir Adnew
- Yale School of Public Health, 135 College Street, New Haven, CT 06510 USA
| | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library, Yale School of Public Health, New Haven, USA
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Zhao D, Fan J, Wang P, Jiang X, Yao J, Li X. Age-specific definition of low anti-Mullerian hormone and associated pregnancy outcome in women undergoing IVF treatment. BMC Pregnancy Childbirth 2021; 21:186. [PMID: 33673814 PMCID: PMC7936413 DOI: 10.1186/s12884-021-03649-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 02/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The age-specific definition of low anti-müllerian hormone (AMH) is lacking. This study aims to define an age-specific reference for low AMH and to evaluate the associated outcome in women undergoing IVF treatment. METHODS A retrospective study was performed in women receiving IVF treatment at the Shenzhen maternity and child healthcare hospital between September 2016 and September 2018. We excluded cases without AMH concentration. Polynomial least-squares regression was used to estimate the age-specific reference ranges for AMH after log-transformed. The age-specific 10th centile was defined as the threshold of low AMH concentration. RESULTS A total of 909 patients were analyzed in this study. The age-specific reference ranges for AMH were established using linear regression model and resulted in an age-specific equation for mean: mean of LnAMH = (- 0.085 × age) + 3.722 (ng/ml, in unit). Women with AMH level higher than 10th centile had favorable outcomes in ovarian stimulation compared to those with low AMH level. In patients younger than 35 years, the rates of clinical pregnancy per transfer and ongoing pregnancy per transfer in the subgroup with AMH level higher than 10th centile were significantly higher than that in the subgroup of low AMH level, 57% versus 31.3% p = 0.003 and 51.9% versus 21.9% p = 0.001, respectively. CONCLUSION Women with AMH lower than age-specific 10th centile had significantly unfavorable outcomes after IVF treatment. The age-specific 10th centile of AMH concentration may be useful to predict the outcome of IVF treatment.
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Affiliation(s)
- Depeng Zhao
- Department of Reproductive Medicine, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Jing Fan
- Department of Reproductive Medicine, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Ping Wang
- Department of Reproductive Medicine, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Xuan Jiang
- Department of Reproductive Medicine, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Jilong Yao
- Department of Reproductive Medicine, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Xuemei Li
- Department of Reproductive Medicine, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China.
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Killion MM. Improving Maternity Care by Eliminating Racism and Inequities. MCN Am J Matern Child Nurs 2021; 46:123. [PMID: 33630497 DOI: 10.1097/nmc.0000000000000699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Molly M Killion
- Molly Killion is the High-Risk Obstetric Coordinator at the University of California, San Francisco Medical Center in San Francisco, CA. The author can be reached via email at
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Tsegaye B, Shudura E, Yoseph A, Tamiso A. Predictors of skilled maternal health services utilizations: A case of rural women in Ethiopia. PLoS One 2021; 16:e0246237. [PMID: 33606676 PMCID: PMC7894870 DOI: 10.1371/journal.pone.0246237] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 01/05/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Maternal health services are affected by complex factors from one setting to another. Consequently, health planners should prioritize different interventions and design appropriate programs to enhance maternal health services utilization. Results of prior studies are conflicting. Furthermore, only few studies were done from antenatal to postnatal continuum of care in Ethiopia. OBJECTIVES This study aimed to assess prevalence and predictors of skilled maternal health services utilization at Dale-Wonsho health and demographic surveillance site of the Hawassa University, South Ethiopia, in 2019. METHODS A community based cross sectional study was conducted from January 1-30; 2019. A total of 682 women who gave birth in the last twelve months were selected by using a two stage sampling technique. Data were collected through face to face interview. Data were entered into Epidata version 3.1. Then, they were exported and analyzed by SPSS version 22. Bi-variable logistic regression analysis was done and variables with p-value less than 0.05 were considered as candidate for multivariable logistic regression analysis. Adjusted Odds Ratios (AOR) with 95% CI were computed, and p-value less than 0.01 was computed to determine the level of significance. RESULT Prevalence of antenatal care, institutional delivery and postnatal care utilizations were 69.1%, 52.1% and 32.7% respectively. Educated women (AOR = 4.72, 95%CI,2.82,7.9), household training (AOR = 8.52,95%CI = 5.5,13.1), middle wealth quantile(AOR = 0.8,95%CI,0.4-0.7), being richest wealth quantile (AOR = 0.16;95%CI = 0.06,0.41) and pregnancy plan (AOR = 3.65,95%CI,1.67-8.0) were factors positively associated with antenatal care utilization. Husband education (AOR = 4.96,95CI,3.08-8.0), and antenatal care (AOR = 5.9; 95%CI,3.87,9.1) were factors associated with institutional delivery. Maternal education (AOR = 2.5,95CI,1.4-4.4), information about postnatal care service utilization (AOR = 3.6,95CI,2.1,6.2) and women autonomy(AOR = 6.1,95CI,3.8,9.7) were positively associated with postnatal care service. CONCLUSION Prevalence of antenatal care, institutional delivery and postnatal care services were lower than the targeted plan. Policy makers should focus on capacity building of women both economically and academically. So, women should be more autonomous to utilize health services effectively. Moreover, awareness creation among women should be enhanced about maternal health service.
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Affiliation(s)
- Berhan Tsegaye
- Department of Midwifery, Hawassa University Health Science College, Hawassa, Ethiopia
| | - Elsabet Shudura
- Department of Sidama Region Health Department, Hawassa, Ethiopia
| | - Amanuel Yoseph
- Department of Public Health, Hawassa University Health Science College, Hawassa, Ethiopia
| | - Alemu Tamiso
- Department of Public Health, Hawassa University Health Science College, Hawassa, Ethiopia
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van der Pijl MSG, Kasperink M, Hollander MH, Verhoeven C, Kingma E, de Jonge A. Client-care provider interaction during labour and birth as experienced by women: Respect, communication, confidentiality and autonomy. PLoS One 2021; 16:e0246697. [PMID: 33577594 PMCID: PMC7880498 DOI: 10.1371/journal.pone.0246697] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/23/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Respectful Maternity Care is important for achieving a positive labour and birth experience. Client-care provider interaction-specifically respect, communication, confidentiality and autonomy-is an important aspect of Respectful Maternity Care. The aim of this study was twofold: (1) to assess Dutch women's experience of respect, communication, confidentiality and autonomy during labour and birth and (2) to identify which client characteristics are associated with experiencing optimal respect, communication, confidentiality and autonomy. METHODS Pregnant women and women who recently gave birth in the Netherlands were recruited to fill out a validated web-based questionnaire (ReproQ). Mean scores per domain (scale 1-4) were calculated. Domains were dichotomised in non-optimal (score 1, 2,3) and optimal client-care provider interaction (score 4), and a multivariable logistic regression analysis was performed. RESULTS Of the 1367 recruited women, 804 respondents completed the questionnaire and 767 respondents completed enough questions to be included for analysis. Each domain had a mean score above 3.5. The domain confidentiality had the highest proportion of optimal scores (64.0%), followed by respect (53.3%), communication (45.1%) and autonomy (36.2%). In all four domains, women who gave birth at home with a community midwife had a higher proportion of optimal scores than women who gave birth in the hospital with a (resident) obstetrician or hospital-based midwife. Lower education level, being multiparous and giving birth spontaneously were also significantly associated with a higher proportion of optimal scores in (one of) the domains. DISCUSSION This study shows that on average women scored high on experienced client-care provider interaction in the domains respect, communication, confidentiality and autonomy. At the same time, client-care provider interaction in the Netherlands still fell short of being optimal for a large number of women, in particular regarding women's autonomy. These results show there is still room for improvement in client-care provider interaction during labour and birth.
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Affiliation(s)
- Marit S. G. van der Pijl
- Amsterdam University Medical Centre (UMC), Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam, The Netherlands
- * E-mail:
| | - Marlies Kasperink
- Amsterdam University Medical Centre (UMC), Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam, The Netherlands
| | - Martine H. Hollander
- Amalia Children’s Hospital, Department of Obstetrics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Corine Verhoeven
- Amsterdam University Medical Centre (UMC), Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam, The Netherlands
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Elselijn Kingma
- Department of Philosophy, University of Southampton, Southampton, United Kingdom
- Department of Industrial Engineering & Innovation Sciences, Philosophy & Ethics, Technical University Eindhoven, Eindhoven, The Netherlands
| | - Ank de Jonge
- Amsterdam University Medical Centre (UMC), Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam, The Netherlands
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