Women's autonomy and maternal healthcare service utilization in Ethiopia

Married women's decision-making autonomy in the household and maternal and neonatal healthcare utilization and associated factors in Debretabor, northwest Ethiopia

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 1^st to 30^th, 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.

Determinants of wife-beating acceptance among reproductive age women in Ethiopia: a multilevel analysis of 2016 Ethiopian demographic and health survey

Background

There is limited national representative evidence on determinants of women’s acceptance of wife-beating especially; community level factors are not investigated in Ethiopia. Thus, this study aimed to assess individual and community-level factors associated with acceptance of wife beating among reproductive age women in Ethiopia.

Methods

Secondary data analysis was done on 2016 Ethiopian Demographic and Health Survey data. A total of 15,683 weighted reproductive age group women were included in the analysis. Multi-level mixed-effect logistic regression analysis was done by Stata version 14.0 to identify individual and community-level factors. An adjusted odds ratio with a 95% confidence interval was used to show the strength and direction of the association. Statistical significance was declared at p value less than 0.05 at the final model.

Result

Individual-level factors significantly associated with acceptance of wife-beating among women were; being Muslim follower [AOR = 1.3, 95% CI = (1.1, 1.5)], Being married [AOR = 1.3, 95% CI = (1.1, 1.6)], attending primary, secondary and higher education [AOR = 0.8, 95% CI = (0.7, 0.9)], [AOR = 0.4, 95% CI = (0.3, 0.5)], [AOR = 0.3, 95% CI (0.2, 0.4)] respectively. From community level factors, living in Somali [AOR = 0.2 95% CI = (0.1, 0.3)], Addis Ababa [AOR = 0.3, 95%CI = (0.2, 0.5)] and Dire Dawa [AOR = 0.5, 95% CI = (0.3, 0.7)] were 80%, 70% and 50% less likely accept wife-beating when compare to women who live in Tigray region, respectively. Live in high proportion of poor community [AOR = 1.2, 95% CI = (1.1, 1.3)], live in low proportion of television exposure communities [AOR = 1.4, 95% CI = (1.2, 2.2)] were significantly associated with acceptance of wife-beating among women in Ethiopia.

Conclusion

Educational status, religion, marital status, region, community-level wealth, and community level of television exposure had a statistical association with women’s acceptance of wife-beating. Improving educational coverage, community-level of media exposure, community-level wealth status and providing community-friendly interventions are important to reduce the acceptance of wife-beating among women in Ethiopia.

Decision-making autonomy of women and other factors of anemia among married women in Ethiopia: a multilevel analysis of a countrywide survey

BACKGROUND

Anemia is one of the world's public health problem, especially in developing nations. The majority of women of childbearing age (15-49) are affected by anemia. Women's role in the decision-making process is significant for their health and related issues such as anemia. So far, there is no evidence of women's decision-making autonomy on anemia. Consequently, this study aimed to robustly examine both individual- and group-level women's decision-making autonomy and other determinants of anemia among married women in Ethiopia.

METHODS

We examined data from an Ethiopian demographic and health survey conducted in 2016. Our analysis included 9220 married women of childbearing age (15-49 years). For bivariate analysis, we applied the chi-squared (X2) test. The relationship between individual and group-level women's decision-making autonomy and anemia was assessed using multilevel binary logistic regression models while adjusting other socio-demographic and economic characteristics.

RESULTS

In this study the magnitude of anemia was 30.5% (95% CI; 29.5-31.4). According to our multilevel analysis, group-level women's autonomy was found to be negatively related with anemia than individual-level women's autonomy (AOR = 0.53, 95% CI = 0.41-0.69). In addition, the indicator of women's wealth index at group level was a protective factor (AOR = 0.68, 95% CI =0.51-0.90) to develop anemia. Among individual-level indicators women's age (AOR = 0.73, 95% CI = 0.60-0.89), use of contraceptive (AOR = 0.66, 95% CI = 0.55-0.81), BMI (AOR = 0.71, 95% CI = 0.59-0.86) and employment status (AOR = 0.88, 95% CI = 0.79-0.98) were negatively related with anemia. While women who follow Muslim religion (AOR = 1.62, 95% CI = 1.32-1.97,), women who had five and above number of children (AOR = 93, 95% CI = 1.53-2.46), and who were pregnant (AOR = 1.21, 95% CI = 1.04-1.40) were positively associated with anemia. Our final model showed that around 27% of the variability of having anemia was because of group-level differences (ICC = 0.27, P < 0.001). In addition, both individual and group-level factors account for 56.4% of the variance in the in the severity of anemia across communities (PCV = 56.4%).

CONCLUSIONS

Our study showed that empowering women within households is not only an important mechanism to reduce anemia among married women but also serves as a way to improve the lives of other women within the society.

An Association between Maternal Occupations and Low Birth Weight Infants in Japan from 1995 to 2015

Differences in low birth weight rate depending on maternal socioeconomic characteristics have not yet been demonstrated using the Vital Statistics in Japan; therefore, this study aimed to investigate these differences according to maternal occupations. “Report of Vital Statistics: Occupational and Industrial Aspects” and the Vital Statistics in Japan were used every five years from 1995 to 2015. Nine types of occupations were compared. The low birth weight rate was calculated according to maternal occupations and year. Also, the standardized low birth weight ratio was obtained by dividing the number of low-birth-weight infants for each maternal occupation by an expected number of low birth weight infants. The standardized low birth weight ratio for manual workers was the highest among all occupations from 2000 to 2015, and it was significantly higher than one throughout the years. The ratio for clerical workers was also significantly higher than one from 1995 to 2010. Whereas, the ratio for farmers was significantly lower than one in most of the years. It was suggested that health guidance and prenatal care are particularly needed for manual workers, and a study investigating the differences in prenatal characteristics among maternal occupations is necessary for finding a reason for disparity.

Individual and community level factors associated with unintended pregnancy among pregnant women in Ethiopia

Unintended pregnancy is among the major challenges of public health and a major reproductive health issue, due to its implications on the health, economic and social life of a woman and her family mainly in low and middle-income countries, particularly sub-Saharan Africa. The study aimed to assess unintended pregnancy and associated factors among pregnant women in Ethiopia using multilevel analysis from the EDHS 2016. We used the data from the 2016 Ethiopian Demographic and Health Survey, comprised of 1122 pregnant women. The prevalence of unintended pregnancy was determined through descriptive statistics and multilevel logistic regression was performed to identify factors associated with unintended pregnancy. Variables with a p-value < 0.05 in the selected model were considered as significantly associated and an adjusted odds ratio was used to determine the strength and direction of the association. The prevalence of unintended pregnancy was 29.7% (CI 27.0%, 32.4%), of which 20.4% were mistimed and 9.3% unwanted. Being multi-para and fertility preference to have no more child were associated with a higher risk of unintended pregnancy whereas husbands' polygamy relation, having no women autonomy, and living in Afar and Somali regions showed a less likely risk of experiencing an unintended pregnancy. This study showed that the proportion of women who experienced unintended pregnancy is considerably high. Parity, fertility preference, polygamy relation, women autonomy, and region were identified factors associated with unintended pregnancy. Therefore, policymakers at all levels, reproductive health experts, and concerned organizations should emphasize minimizing unintended pregnancy targeting the regional variation at large. Researchers have to explore the regional variations through a qualitative study.

Individual, socio-cultural, and health facility factors affecting men's involvement in facility-based childbirth in Southwest, Ethiopia: A mixed method study

Introduction:

Traditionally, men are not supposed to take part in maternal health issues in many cultures. Nevertheless, pregnancy care and childbirth are the most crucial matters of reproductive health influenced by men. Hence, the aim of this study was to identify individual, sociocultural, and health facility factors affecting men’s involvement in facility-based childbirth in Southwest, Ethiopia.

Objectives:

The aim of this study was to identify individual, sociocultural, and health facility factors affecting men’s involvement in facility-based childbirth in Southwest, Ethiopia.

Methods:

A community-based cross-sectional study accompanied with a qualitative method was carried out from 1 July to 30 August 2019. A multistage cluster sampling technique was employed to recruit study participants. Descriptive statistics, frequencies, proportions, and mean were calculated, and the results of the analysis were presented in text, tables, and graphs. A multivariate logistic regression model was fitted to investigate the independent effect of each explanatory variable on the likelihood of men’s involvement in facility-based childbirth. Qualitative data were analyzed thematically using OpenCode 4.0 software.

Results:

Out of 800 men, only 36.5% (95% confidence interval: 33.3%–39.6%) were found to have involved in facility-based childbirth. Several factors were associated with men’s involvement in facility-based childbirth of this, being in the age group of 40–49 (adjusted odds ratio 5.04, 95% confidence interval: 2.49–10.20), attaining secondary education and above (adjusted odds ratio 2.14, 95% confidence interval: 1.53–5.60), and having sufficient knowledge of danger signs during pregnancy (adjusted odds ratio 5.65, 95% confidence interval: 3.25–7.46) associated with men’s involvement in facility-based childbirth.

Conclusion:

Relevant entities had better design-specific educational programs targeting younger age groups, those with lower schooling, and had previous bad obstetrics outcomes. Involving elders and religious leaders in the reproductive health program could also help in overcoming the existing cultural barriers. Moreover, creating a men-friendly facility environment and extensively engaging medias are suggested to improve men’s involvement in the study area.

Deworming Coverage and its Predictors among Ethiopian Children Aged 24 to 59 Months: Further Analysis of EDHS 2016 Data Set

Intestinal parasitic infections are the major public health problem globally, mostly in developing countries. World Health Organization recommends deworming to all at-risk people living in endemic areas as a prevention or intervention strategy. Therefore this study aimed to assess the deworming coverage and its predictors among Ethiopian children aged 24-59 months. The study analyzed retrospectively cross-sectional data on a weighted sample of 5,948 children aged 24-59 months nested within 645 clusters after extracting from the Ethiopian Demographic health survey. Bivariable and multivariable logistic regression was employed to assess the association of variables. Predictors at p-value < 0.25 were entered into the multivariable logistic regression model, and statistical significance was declared at P-value < 0.05. In this study, the prevalence of maternal reported deworming supplements among children aged 24-59 months was 15.1%. Predictive variables significantly associated with deworming supplementation include maternal media exposure, maternal control of household healthcare decisions, institutional healthcare delivery, and child vitamin-A supplementation. Having history of a diarrheal disease, maternal and paternal education, and family size were also statistically significant predictors of deworming supplements. Therefore, deworming supplementation among children is low. Maternal education and employment, paternal education, family size, decision-making process, maternal media exposure, place of delivery, vitamin-A supplementation, and a having history of diarrhea were predictors of deworming supplements. Multifaceted interventions aimed at those predictors should be given emphasis.

Women's experiences and satisfaction with maternal referral service in Northern Ghana: A qualitative inquiry

OBJECTIVE

To gain insights and improve existing referral structures with maternity care in Northern region of Ghana, this study explored the referral experiences and satisfaction of women.

RESEARCH DESIGN

Twenty women referred to the Tamale Teaching Hospital for maternal health conditions were interviewed along with three husdands of these women between January and April 2020. An interview guide was used in individual face-to-face semi-structured interviews. The transcripts were inductively coded using content analysis. The study was guided by the three delays model and the availability, accessibility, acceptability and quality framework.

FINDINGS

The study revealed seven key themes. These are women's involvement in referral decision; available health workers and care at the first facility; inadequate transportation; communication between facilities; quality of care at the receiving hospital; worth the time and money; and women's companions during referral. While several women acknowledged and appreciated the care and emotional support they received in the hospitals they first presented to, some women reported poor attitudes of healthcare providers. Most women acknowledged that there was no communication between the facilities for the referral. A woman's socioeconomic status appeared to determine the respect and support she received from healthcare providers.

KEY CONCLUSIONS

To ensure a responsive and efficient referral service, the central government of Ghana should commit to ensuring that each district hospital has at least one ambulance for effective emergency transportation. Career progression opportunities need to be explored for health workers in northern Ghana to attract and retain more professionals. To prevent abuse and ensure empathetic and supportive care, testimonial videos may help health providers to assess the services they provide to women. During referral, inter-facility communication can be strengthened through effective supervision and dedicated mobile phones for communication between health facilities.

Associations of early marriage and early childbearing with anemia among adolescent girls in Ethiopia: a multilevel analysis of nationwide survey

Background

Early marriage and early childbearing are common practices in Ethiopia. Girls who get married and give birth at a very young age are more likely to experience several health problems including anemia among others. However, the effects of early marriage and early childbearing on anemia status of adolescent girls have not been quantified in previous studies. In this study, we assessed whether early marriage and early childbearing measured at both individual and community levels are associated with adolescent anemia.

Methods

We analyzed data from the 2016 demographic and health survey of Ethiopia. Our study focused on 3172 late female adolescents (15–19 years). We used the chi-squared test and spearman correlation coefficients for bivariate analysis. The relationship between early marriage and childbearing with anemia was evaluated using multilevel binary logistic regression models while controlling other determinants.

Results

Overall prevalence of anemia among female adolescents was 23.8% (95% CI; 22.3–25.2). Our multivariable multilevel analysis showed that individual-level marital status (AOR = 1.53, 95% CI = 1.06–2.02) and community-level childbearing status (AOR = 2.80, 95% CI 1.25–6.29) were positively associated with anemia among female adolescents.

Conclusion

Our findings show the presence of significant association between early marriage & early childbearing with adolescent anemia. Therefore, there is a need for effective policies and programs to end the practice of early child marriage and the consequent adolescent pregnancy in Ethiopia. This will help to improve nutritional status of adolescent girls as well as nutritional outcomes of their children.

Determinants of practice of preconception care among women of reproductive age group in southern Ethiopia, 2020: content analysis

BACKGROUND

Preconception care (PCC) is a series of biomedical, mental, and psycho-social health services provided to women and a couple before pregnancy and throughout subsequent pregnancies for desired outcomes. Millions of women and new-borns have died in low-income countries due to impediments that arise before and exaggerate during pregnancies that are not deal with as part of pre-conception care. To the best of our knowledge, however, there is a lack of information about preconception care practice and its determinants in southern Ethiopia, including the study area. This study was therefore planned to assess the practice of preconception care and its determinants among mothers who recently gave birth in Wolkite town, southern Ethiopia, in 2020.

METHODS

A community-based cross-sectional study was conducted from February 1 to 30, 2020. A total of 600 mothers who have given birth in the last 12 months have been randomly selected. A two-stage sampling technique was employed. For data collection, a pre-tested, semi-structured questionnaire was used. The data was encoded and entered into Epi-Data version 3.1 and exported for analysis to SPSS version 23. Household wealth status was determined through the application of principal component analysis(PCA). The practice PCC was considered as a count variable and measured as a minimum score of 0 and a maximum of 10. A bivariable statistical analysis was performed through analysis of variance (ANOVA) and independent t-tests and variables with a p-value of < 0.05 were eligible for the generalized linear regression model. To see the weight of each explanatory variable on PCC utilization, generalized linear regression with a Poisson link was done.

RESULTS

Of the sampled 600 participants, 591 took part in the study, which yielded a response rate of 98.8%.The mean (± SD) score of the practice of PCC was 3.94 (± 1.98) with minimum and maximum scores of 0 and 10 respectively. Only 6.4% (95%CI: 4.6, 8.6) of mothers received all selected items of PCC services. Thecommonest item received by 67.2% of mothers was Folic acid supplementation, while 16.1% of mothers received the least item of optimizing psychological health. Education status of mother[AOR 0.74, 95%CI 0.63, 0.97], time spent to access nearby health facilities [AOR 0.69, 95%CI 0.58, 0.83], availability of PCC unit [AOR 1.46; 95%CI 1.17, 1.67], mother's knowledge on PCC [AOR 1.34, 95%CI 1.13, 1.65], being a model household [AOR 1.31, 95%CI 1.18, 1.52] and women's autonomy in decision making [AOR 0.75, 95%CI 0.64, 0.96] were identified as significant predictors of practice of PCC.

CONCLUSION

The uptake of WHO-recommended PCC service elements in the current study area was found to be unsatisfactory. Stakeholders must therefore increase their efforts to align PCC units with existing MNCH service delivery points, improve women's decision-making autonomy, and focus on behavioral change communication to strengthen PCC practice. Plain language summary Preconception care (PCC) is a series of biomedical, mental, and psycho-social health services provided to women and a couple before pregnancy and throughout subsequent pregnancies for better endings. The main goal of the PCC is to improve maternal and child health outcomes, by-promoting wellness and providing preventive care. It can also be seen as an earlier chance for teenage girls, mothers, and children to live a better and longer-term healthy life. Pieces of PCC service packages suggested by the World Health Organization(WHO) are, micronutrient supplementation (Folate supplementation), infectious disease (STI/HIV) screening and testing, chronic disease screening and management, healthy diet therapy, vaccination, prevention of substance use (cessation of cigarette smoking and too much alcohol consumption), optimizing psychological health, counseling on the importance of exercise and reproductive health planning and implementation. Millions of women and new-borns have died in low-income countries due to impediments that arise before and exaggerate during pregnancies that are not deal with as part of pre-conception care. To the best of our knowledge, however, there is a lack of information about preconception care practice and its determinants in southern Ethiopia, including the study area. This study was therefore planned to evaluate the practice of preconception care and its determinants among mothers who recently gave birth in Wolkite town, southern Ethiopia, in 2020. Mothers who have given birth in the last 12 months have been randomly selected Household wealth status was determined through the application of principal component analysis(PCA). To see the weight of each explanatory variable on PCC, generalized linear regression with a Poisson type was done. Accordingly, the Education status of the mother, time spent to access nearby health facilities, availability of PCC unit, mother's knowledge on PCC, being a model household, and women's autonomy in decision making were identified as significant predictors of practice of PCC. Stakeholders must therefore increase their efforts to align PCC units with existing MNCH service delivery points, improve women's decision-making autonomy, and focus on behavioral change communication to strengthen PCC practice.

Spatial variability in factors influencing maternal health service use in Jimma Zone, Ethiopia: a geographically-weighted regression analysis

BACKGROUND

Persisting within-country disparities in maternal health service access are significant barriers to attaining the Sustainable Development Goals aimed at reducing inequalities and ensuring good health for all. Sub-national decision-makers mandated to deliver health services play a central role in advancing equity but require appropriate evidence to craft effective responses. We use spatial analyses to identify locally-relevant barriers to access using sub-national data from rural areas in Jimma Zone, Ethiopia.

METHODS

Cross-sectional data from 3727 households, in three districts, collected at baseline in a cluster randomized controlled trial were analysed using geographically-weighted regressions. These models help to quantify associations within women's proximal contexts by generating local parameter estimates. Data subsets, representing an empirically-identified scale for neighbourhood, were used. Local associations between outcomes (antenatal, delivery, and postnatal care use) and potential explanatory factors at individual-level (ex: health information source), interpersonal-level (ex: companion support availability) and health service-levels (ex: nearby health facility type) were modelled. Statistically significant local odds ratios were mapped to demonstrate how relevance and magnitude of associations between various explanatory factors and service outcomes change depending on locality.

RESULTS

Significant spatial variability in relationships between all services and their explanatory factors (p < 0.001) was detected, apart from the association between delivery care and women's decision-making involvement (p = 0.124). Local models helped to pinpoint factors, such as danger sign awareness, that were relevant for some localities but not others. Among factors with more widespread influence, such as that of prior service use, variation in estimate magnitudes between localities was uncovered. Prominence of factors also differed between services; companion support, for example, had wider influence for delivery than postnatal care. No significant local associations with postnatal care use were detected for some factors, including wealth and decision involvement, at the selected neighbourhood scale.

CONCLUSIONS

Spatial variability in service use associations means that the relative importance of explanatory factors changes with locality. These differences have important implications for the design of equity-oriented and responsive health systems. Reductions in within-country disparities are also unlikely if uniform solutions are applied to heterogeneous contexts. Multi-scale models, accommodating factor-specific neighbourhood scaling, may help to improve estimated local associations.

Early childhood caries: Are maternal psychosocial factors, decision-making ability, and caries status risk indicators for children in a sub-urban Nigerian population?

OBJECTIVE

Early childhood caries (ECC) is caries in children below the age of 72 months. The aim of the study was to determine the association of maternal psychosocial factors (general anxiety, dental anxiety, sense of coherence, parenting stress, fatalism, social support, depressive symptoms, and executive dysfunction), decision-making abilities, education, income and caries status with the prevalence and severity of ECC among children resident in Ile-Ife, Nigeria.

METHODS

A dataset of 1549 mother-child (6-71-months-old) dyads collected through examinations and a household survey, using validated psychometric tools to measure the psychosocial factors, were analyzed. The DMFT for the mothers and the dmft for the child were determined. The association between maternal psychosocial factors, education, income, and decision-making ability, the prevalence of maternal caries, and the prevalence of ECC was determined using logistic regression analysis.

RESULTS

The prevalence of maternal caries was 3.3%, and the mean (standard deviation-SD) DMFT was 0.10 (0.76). The ECC prevalence was 4.3%, and the mean (SD) dmft was 0.13 (0.92). There was no significant difference between the prevalence and severity of maternal caries and ECC by maternal age, education, income, or decision-making abilities. There was also no significant difference in maternal caries, ECC prevalence and ECC severity by maternal psychosocial factors. The only significant association was between the prevalence of caries in the mother and children: children whose mothers had caries were over six times more likely to have ECC than were children with mothers who had no caries (AOR: 6.67; 95% CI 3.23-13.79; p < 0.001).

CONCLUSION

The significant association between ECC and maternal caries prevalence suggests that prenatal oral health care for mothers may reduce the risk for ECC.

Magnitude and associated factors of unmet need for family planning among rural women in Ethiopia: a multilevel cross-sectional analysis

OBJECTIVE

This study was aimed to assess the magnitude and associated factors of unmet need for family planning among rural women in Ethiopia.

DESIGN

Cross-sectional study.

SETTING

Ethiopia.

PARTICIPANTS

Reproductive age group women.

PRIMARY OUTCOME

Unmet need for family planning.

METHODS

This study drew data from Ethiopian Demographic and Health Survey, which was conducted from 18 January to 27 June 2016. A total of 8327 rural reproductive-aged (15-49 years) women were included. A two-level multivariable logistic regression model was carried out to identify individual and community-level factors associated with unmet need for family planning. Adjusted OR (AOR) with a 95% CI was used to assess the strength of association between independent and dependent variables.

RESULTS

The overall unmet need for family planning among rural women was 24.08% (95% CI 23.17 to 25.01), of which 14.79% was for spacing and 9.29% for limiting. Number of children (AOR=1.15; 95% CI 1.07 to 1.24) and working status of women (AOR=1.18; 95% CI 1.02 to 1.37) were significantly associated with a higher odds of unmet need for family planning. However, women with primary education (AOR=0.87; 95% CI 0.74 to 0.94), women married at age 18 or later (AOR=0.82; 95% CI 0.70 to 0.96), women from households with high wealth index (AOR=0.77; 95% CI 0.64 to 0.94), women who deem distance to a health facility as not a big problem (AOR=0.85; 95% CI 0.73 to 0.99), women from communities with a high percentage of educated women (AOR=0.73; 95% CI 0.59 to 0.89) and women who live in communities with high media exposure (AOR=0.81, 95% CI 0.68 to 0.98) were significantly associated with a lower odds of unmet needs for family planning.

CONCLUSION

Unmet need for family planning among reproductive-aged women in rural Ethiopia was high. Number of children, working status of women, women's education, age at first marriage, household wealth, distance to a health facility, community women's education and community media exposure were significantly associated with unmet needs for family planning. Therefore, to reduce unmet need for family planning, public health policymakers should consider both individual and community-level factors when designing FP programmes and emphasis should be given to high-risk populations.

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

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.

Factors affecting the utilization of antenatal care services among women in Guinea: a population-based study

INTRODUCTION

Evidence suggests that a better understanding of determinants of antenatal care (ANC) utilization is crucial to reducing maternal and child deaths. Little is known about the utilization of ANC services in Guinea.

OBJECTIVE

The aim of this study was to explore factors determining utilization of skilled ANC in Guinea.

METHODS

This study focused on a sample of 7812 ever married women. Using multivariate logistic regression, factors associated with the utilization of ANC were identified. The output of the multivariate logistic regression was presented using adjusted odds ratio and the corresponding 95% confidence interval (CI).

RESULTS

Several factors had significant association with utilization of skilled ANC service in Guinea: having decision-making power (2.21, 95% CI: 1.63, 3.00), employment status (1.86, 95% CI: 1.39, 2.48), media exposure (1.60, 95% CI: 1.26, 2.02), maternal education (2.68, 95% CI: 1.36, 5.28), husband/partner education status (1.66, 95% CI: 1.08, 2.55), household economic status (2.19, 95% CI: 1.40, 3.44), place of residence (0.29, 95% CI: 0.16, 0.50) and ethnicity (0.40, 95% CI: 0.23, 0.69).

CONCLUSIONS

These findings suggest a variety of socio-demographic and economic factors as well as media exposure are associated with women's use of ANC. Policymakers should implement appropriate measures to address the existing variations and gaps in ANC services utilization among different subgroups of women in Guinea.

Maternal health care services utilization amidstCOVID-19 pandemic in West Shoa zone, central Ethiopia

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.

Women's empowerment and child growth faltering in Ethiopia: evidence from the Demographic and Health Survey

BACKGROUND

Despite numerous national and international efforts to alleviate child growth faltering, it remains a global health challenge. There is a growing body of literature that recognizes the importance of women's empowerment in a wide range of public health topics, such as the utilization of maternal healthcare services, agricultural productivity, and child nutrition. However, in Ethiopia, the relationship between women's empowerment and child nutritional status is not studied at the national level. This study aimed to determine the association between women's empowerment and growth faltering in under-5 children in Ethiopia.

METHODS

The data source for this analysis is the 2016 Ethiopian Demographic and Health Survey (EDHS): a nationally representative household survey on healthcare. The EDHS employed a two-stage stratified cluster sampling technique. We computed standard women's empowerment indices, following the Survey-based Women's emPowERment index approach. A multilevel logistic regression model that accounted for cluster-level random effects was used to estimate the association between women's empowerment and child growth faltering (stunting, wasting and underweight).

RESULTS

Attitude to violence, social independence, and decision-making were the three domains of women's empowerment that were associated with child growth faltering. One standard deviation increase in each domain of empowerment was associated with a reduction in the odds of stunting: attitude towards violence (AOR = 0.92; 95% CI 0.88-0.96; p < 0.001), social independence (AOR = 0.95; 95% CI 0.89-0.99; p = 0.049), and decision-making (AOR = 0.93; 95% CI 0.87-0.99; p = 0.023). Similarly, each standard deviation increase in attitude towards violence (AOR = 0.93; 95% CI 0.89-0.98; p = 0.008), social independence (AOR = 0.91; 95% CI 0.86-0.97; p = 0.002), and decision-making (AOR = 0.92; 95% CI 0.86-0.99; p = 0.020) were associated with a decrease in the odds of having underweight child.

CONCLUSIONS

Ensuring women's empowerment both in the household and in the community could have the potential to decrease stunting and underweight in a rapidly developing country like Ethiopia. Policymakers and health professionals need to consider women's empowerment in this unique context to improve nutritional outcomes for children and alleviate growth faltering.

Multilevel analysis of the role of women's empowerment on use of contraceptive methods among married Cambodian women: evidence from demographic health surveys between 2005 and 2014

Background

The use of contraceptives is an essential public health concept that improves overall safe motherhood and infant health. Women empowerment has been reported to influence health behaviors in women. With recent efforts to increase access to contraceptive methods, uptake of the same remains a challenge in Cambodia. There are limited studies that have examined the role of women’s empowerment at both individual- and community- level on contraceptive use in Cambodia. This study examined the individual- and community-level factors associated with contraceptive use among Cambodian married women between 2005 and 2014.

Methods

Data from 2005, 2010, and 2014 Cambodia Demographic and Health Surveys were used to analyze 2211; 10,505; and 10,849 women, respectively. Multilevel binary and multinomial logistic regression models were applied to assess the association between individual- and community- level factors, and the use of contraceptive methods.

Results

The prevalence of using modern contraceptive methods increased over time (i.e., 29.0, 38.1, and 42.3% in 2005, 2010, and 2014, respectively). At the individual level, women who attained secondary and higher education were more likely to use any contraceptives [adjusted odds ratio (aOR) = 1.43, 95% confidence interval (CI) = 1.22–1.68, and aOR = 1.23, 95% CI = 1.05–1.44 in 2010 and 2014, respectively] compared with those with no formal education. Similarly, having a high workforce participation level was significantly associated with increased likelihood of using any contraceptive methods [aOR = 1.12, 95% CI = 1.00–1.26, aOR = 1.44, 95% CI = 1.29–1.60 and in 2010 and 2014, respectively]. Other factors such as age at first marriage, residence, and having a health insurance were associated with contraceptive use. The proportional change in variance showed that about 14.3% of total variations in the odds of contraceptive use across the communities were explained by both individual- and community-level factors. Moreover, the intraclass correlation showed that about 5.2% of the total variation remained unexplained even after adjustments.

Conclusion

Both individual- and community- level factors influenced contraceptive use in Cambodia. When designing programs to improve contraceptive use, contextual influences should be taken into account for the effectiveness of the programs.

Women's autonomy and utilization of maternal healthcare in India: Evidence from a recent national survey

OBJECTIVE

The present study aims to examine the association between women's decision-making autonomy and utilization of maternal healthcare services among the currently married women in India.

METHODS

A total of 32,698 currently married women aged 15-49 years who had at least one live birth in the past five years preceding the survey and had information regarding autonomy collected by the National Family Health Survey 2015-16 were used for analysis. Bivariate and multivariate logistic regression models were employed for the analyses of this study.

RESULTS

Utilization of maternal healthcare services was higher among the women having a high level of decision-making autonomy compared to those who had a low autonomy in the household. The regression results indicate that women's autonomy was significantly associated with increased odds of maternal healthcare services in India. Women with high autonomy had 37% and 33% greater likelihood of receiving ANC (AOR: 1.37, 95% CI: 1.25-1.50) and PNC care (AOR: 1.33, 95% CI: 1.24-1.42) respectively compared to women having low autonomy. However, no significant association was observed between women's autonomy and institutional delivery in the adjusted analysis.

CONCLUSION

This study recommends the need for comprehensive strategies involving improvement of women's autonomy along with expansion of education, awareness generation regarding the importance of maternity care, and enhancing public health infrastructure to ensure higher utilization of maternal healthcare services that would eventually reduce maternal mortality.

Lost to Follow-up and Predictors Among HIV-Exposed Infants in Northwest Ethiopia

Introduction

Even though advancement in mother-to-child HIV transmission prevention services is observed, many infants are lost to follow-up and could not access the full package of mother-to-child HIV transmission prevention services as a result. This is one of the obstacles to the effectiveness of the program. Therefore, determining the magnitude of lost to follow-up and its predictors is important among HIV-exposed infants.

Method

This institution-based retrospective cohort study was conducted from August 2013 to June 2018 at the University of Gondar Comprehensive Specialized Hospital. We retrieved charts of 423 child–mother pairs through a simple random sampling technique. Data collectors extracted data by using a data extraction tool adapted from the Ethiopian Federal Ministry of Health HIV-exposed infant follow-up form. Bivariable and multivariable Cox regression models were fitted to identify predictors of lost to follow-up.

Result

A total of 402 child–mother pairs were included in the study. Of the study participants, 6.0% were lost to follow-up for more than 3 months before the declaration of their HIV status. Born from rural residence mother (AHR = 3.5; 95% CI 1.549–7.894), infants whose mothers have three and more children (AHR = 3; 95% CI 1.284–6.963), and low birth weight infants (AHR = 3.2; 95% CI 1.055–9.450) were independent predictors of lost to follow-up among HIV-exposed infants.

Conclusion

Significant numbers of infants were unable to access full HIV diagnosis and care services as a result of loss to follow-up. Special consideration for mothers having large numbers of children, rural residence, and low birth weight infants could be an important intervention to decrease lost to follow-up.

Prevalence and determinants of uterine rupture in Ethiopia: a systematic review and meta-analysis

Uterine rupture is a serious public health concern that causes high maternal and perinatal morbidity and mortality in the developing world. Few of the studies conducted in Ethiopia show a high discrepancy in the prevalence of uterine rupture, which ranges between 1.6 and 16.7%. There also lacks a national study on this issue in Ethiopia. This systematic and meta-analysis, therefore, was conducted to assess the prevalence and determinants of uterine rupture in Ethiopia. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic review and meta-analysis of studies. All observational published studies were retrieved using relevant search terms in Google scholar, African Journals Online, CINHAL, HINARI, Science Direct, Cochrane Library, EMBASE and PubMed (Medline) databases. Newcastle–Ottawa assessment checklist for observational studies was used for critical appraisal of the included articles. The meta-analysis was done with STATA version 14 software. The I² test statistics were used to assess heterogeneity among included studies, and publication bias was assessed using Begg's and Egger's tests. Odds ratio (OR) with a 95% confidence interval (CI) was presented using forest plots. A total of twelve studies were included in this study. The pooled prevalence of uterine rupture was 3.98% (95% CI 3.02, 4.95). The highest (7.82%) and lowest (1.53%) prevalence were identified in Amhara and Southern Nations, Nationality and Peoples Region (SNNPR), respectively. Determinants of uterine rupture were urban residence (OR = 0.15 (95% CI 0.09, 0.23)), primipara (OR = 0.12 (95% CI 0.06, 0.27)), previous cesarean section (OR = 3.23 (95% CI 2.12, 4.92)), obstructed labor(OR = 12.21 (95% CI 6.01, 24.82)), and partograph utilization (OR = 0.12 (95% CI 0.09, 0.17)). Almost one in twenty-five mothers had uterine rupture in Ethiopia. Urban residence, primiparity, previous cesarean section, obstructed labor and partograph utilization were significantly associated with uterine rupture. Therefore, intervention programs should address the identified factors to reduce the prevalence of uterine rupture.

'Men are not playing their roles', maternal and child nutrition in Nanoro, Burkina Faso

OBJECTIVE

To collect context-specific insights into maternal and child health and nutrition issues, and to explore potential solutions in Nanoro, Burkina Faso.

DESIGN

Eleven focus groups with men and women from eleven communities, facilitated by local researchers.

SETTING

The study took place in the Nanoro Health district, in the West-Central part of Burkina Faso.

PARTICIPANTS

Eighty-six men (18-55 years) and women by age group: 18-25; 26-34 and 35-55 years, participated in the group discussions.

RESULTS

Participants described barriers to optimal nutrition of mothers and children related to a range of community factors, with gender inequality as central. Major themes in the discussions are related to poverty and challenges generated by socially and culturally determined gender roles. Sub-themes are women lacking access to food whilst pregnant and having limited access to health care and opportunities to generate income. Although communities believe that food donations should be implemented to overcome this, they also pointed out the need for enhancing their own food production, requiring improved agricultural technologies. Given the important role that women could play in reducing malnutrition, these communities felt they needed to be empowered to do so and supported by men. They also felt that this had to be carried out in the context of an enhanced health care system.

CONCLUSIONS

Findings reported here highlight the importance of nutrition-sensitive interventions and women's empowerment in improving maternal and child nutrition. There is a need to integrate a sustainable multi-sectorial approach which goes beyond food support.

Individual-, household-, and community-level factors associated with eight or more antenatal care contacts in Nigeria: Evidence from Demographic and Health Survey

INTRODUCTION

Antenatal care (ANC) is a vital mechanism for women to obtain close attention during pregnancy and prevent death-related issues. Moreover, it improves the involvement of women in the continuum of health care and to survive high-risk pregnancies. This study was conducted to determine the prevalence of and identify the associated factors of eight or more ANC contacts in Nigeria.

METHODS

We used a nationally representative cross-sectional data from Nigeria Demographic and Health Survey-2018. A total sample of 7,936 women were included in this study. Prevalence was measured in percentages and the factors for eight or more ANC contacts were examined using multilevel multivariable binary logistic regression model. The level of significance was set at P<0.05.

RESULTS

The prevalence of eight or more ANC contacts in Nigeria was approximately 17.4% (95% CI: 16.1%-18.7%). Women with at least secondary education were 2.46 times as likely to have eight or more ANC contacts, when compared with women with no formal education. Women who use media were 2.37 times as likely to have eight or more ANC contacts, when compared with women who do not use media. For every unit increase in the time (month) of ANC initiation, there was 53% reduction in the odds of eight or more ANC contacts. Rural women had 60% reduction in the odds of eight or more ANC contacts, when compared with their urban counterparts. Women from North East and North West had 74% and 79% reduction respectively in the odds of eight or more ANC contacts, whereas women from South East, South South and South West were 2.68, 5.00 and 14.22 times respectively as likely to have eight or more ANC contacts when compared with women from North Central.

CONCLUSION

The coverage of eight or more ANC contacts was low and can be influenced by individual-, household-, and community-level factors. There should be concerted efforts to improve maternal socioeconomic status, as well as create awareness among key population for optimal utilization of ANC.

Interactions between the Physical and Social Environments with Adverse Pregnancy Events Related to Placental Disorders-A Scoping Review

BACKGROUND

Due to different social and physical environments across Africa, understanding how these environments differ in interacting with placental disorders will play an important role in developing effective interventions.

METHODS

A scoping review was conducted, to identify current knowledge on interactions between the physical and social environment and the incidence of placental disease in Africa.

RESULTS

Heavy metals were said to be harmful when environmental concentrations are beyond critical limits. Education level, maternal age, attendance of antenatal care and parity were the most investigated social determinants.

CONCLUSIONS

More evidence is needed to determine the relationships between the environment and placental function in Africa. The results show that understanding the nature of the relationship between social determinants of health (SDH) and placental health outcomes plays a pivotal role in understanding the risk in the heterogenous communities in Africa.

Associations between women's empowerment and children's health status in Ethiopia

Although women's empowerment has gained attention over the last two decades, our understanding of the associations between different dimensions of women's empowerment and different children's health outcomes is limited. This study aims to measure the extent of women's empowerment and to examine its associations with the children's health status in Ethiopia. Data were obtained from the 2016 Ethiopian Demographic and Health Survey (EDHS). The sample is restricted to a sub-sample of 10,641 women from 15 to 49 years old and their children under the age of five years. We used children's height-for-age and weight-for-height Z-scores and pneumonia and anemia experience as indicators of children's health outcome. Women's empowerment is measured by five indices reflecting their participation in decision-making, attitudes towards wife-beating by husband, barriers to health care access, asset ownership, and socio-economic variables. These indicators of empowerment were constructed using exploratory and confirmatory factor analysis. A Multiple Indicators Multiple Causes (MIMIC) model was employed to examine the relationship between women's empowerment and latent child health outcomes, after controlling for relevant covariates. Results suggests that enhancing women's empowerment in the household in terms of their socio-economic status (i.e., increasing women's access to education, information, media, and promoting saving) was associated with less likelihood of the children's being stunted or wasted (p<0.05). Higher women's empowerment in terms of household decision-making power were also associated with better children's health status measured by the children's experience of pneumonia and anemia (p<0.05). All aspects of women's empowerment are not related with children's health indicators. Women's empowerment dimensions related with child health have a varying degree of association with the different children's health indicators. Gender-specific policies focusing on increasing women's access to education, media, information, and promoting saving and their participation in the household decision making are some of the strategies for improving their children's health and wellbeing.

Multilevel analysis of factors associated with unmet need for family planning among Malawian women

Background

Malawi has a high fertility rate which is also characterized by a relatively high prevalence of unmet need for contraception. However, little is known about the influence of individual- and community- level characteristics on unmet need in Malawi. This study examined the individual- and community- level factors associated with unmet need for family planning (FP) among Malawian women.

Methods

Data from the 2015–16 Malawi demographic and health survey were used to analyze 15, 931 women. The association between individual- and community- level factors and unmet need was assessed using multilevel binary logistic regression models.

Results

The prevalence of total unmet need was 21.0%. Women aged ≥35 years were more likely to have total unmet need [adjusted odds ratio (aOR) = 1.19, 95% confidence interval (CI) = 1.04–1.35] compared with those aged 15–24 years. Women who were married [aOR = 0.41, 95% CI = 0.35–0.48], and those employed [aOR = 0.78, 95% CI = 0.71–0.85] were associated with less likelihood of having total unmet need compared with unmarried, and unemployed women, respectively. At community-level, women from communities with a high percentage of women from rich households [aOR = 0.81, 95% CI = 0.67–0.96], and those from communities with a middle and high percentage of educated women [aOR = 0.86, 95% CI = 0.76–0.96 and aOR = 0.81, 95% CI = 0.70–0.93, respectively] were less likely to have total unmet need for FP compared with those from communities with low percentages of rich and educated women, respectively. The proportional change in variance showed that about 36.0% of total variations in the odds of unmet need across the communities were explained by both individual- and community-level factors. Moreover, the intraclass correlation showed that about 3.0% of the total variation remained unexplained even after controlling for both individual- and community-level factors.

Conclusion

Both individual- and community- level factors influenced unmet need for FP in Malawi. Public health practitioners should conduct community profiling and consider individual and community factors when designing FP programs.

Determinants of safe delivery utilization among Indonesian women in eastern part of Indonesia

Background: Improving maternal health and reducing maternal mortality are part of the United Nations global Sustainable Development Goals for 2030. Ensuring every woman's right to safe delivery is critical for reducing the maternal mortality rate, especially in Indonesia. Our study aimed to identify determinants of safe delivery utilization among women in the eastern Indonesia. Methods: This study was cross-sectional and used data from the 2017 Indonesian Demographic and Health Survey (IDHS). A total of 2,162 women who had their last child in the five years preceding the survey and lived in the eastern part of Indonesia were selected as the respondents. Chi-squared test and binary logistic regression were used to understand the determinants of safe delivery. Results: Higher child rank and interval ≤2 years (OR: 0.30, 95% CI: 0.19-0.47), unwanted pregnancy at time of becoming pregnant (OR: 1.48, 95% CI: 1.05-2.08), richest wealth quintile (OR: 5.59, 95% CI: 3.37-9.30), more than four antenatal care visits (OR: 3.62, 95% CI: 2.73-4.79), rural residence (OR: 0.49, 95% CI: 0.36-0.66), good composite labor force participation (OR: 1.47, 95% CI: 1.15-1.89), and a good attitude towards domestic violence (OR: 1.33, 95% CI: 1.04-1.69) were found to be significantly associated with facility-based delivery. Higher child rank and interval ≤2 years (OR: 0.49, 95% CI: 0.29-0.83), husband/partner having completed secondary or higher education (OR: 2.18, 95% CI: 1.48-3.22), husband/partner having a non-agricultural occupation (OR: 1.35, 95% CI: 1.00-1.81), being in the richest wealth quintile (OR: 15.69, 95% CI: 5.53-44.50), and three other factors were found to be significantly associated with skilled assistance delivery. Conclusions: Safe delivery and facility-based delivery among women in the eastern part of Indonesia were determined by several individual and household factors. An open innovation and partnership process that engages the full range of stakeholders should be developed based on local needs.

Determinants of safe delivery utilization among Indonesian women in eastern part of Indonesia

Background: Improving maternal health and reducing maternal mortality are part of the United Nations global Sustainable Development Goals for 2030. Ensuring every woman's right to safe delivery is critical for reducing the maternal mortality rate. Our study aimed to identify determinants of safe delivery utilization among women in the eastern Indonesia. Methods: This study was cross-sectional and used a secondary data from the 2017 Indonesian Demographic and Health Survey (IDHS). A total of 2,162 women who had their last child in the five years preceding the survey and lived in the eastern part of Indonesia were selected as the respondents. Chi-squared test and binary logistic regression were used to understand the determinants of safe delivery. Results: Higher child rank and interval ≤2 years (OR: 0.30, 95% CI: 0.19-0.47), unwanted pregnancy at time of becoming pregnant (OR: 1.48, 95% CI: 1.05-2.08), richest wealth quintile (OR: 5.59, 95% CI: 3.37-9.30), more than four antenatal care visits (OR: 3.62, 95% CI: 2.73-4.79), rural residence, good composite labor force participation, and a good attitude towards domestic violence were found to be significantly associated with delivery at health facility. Higher child rank and interval ≤2 years (OR: 0.49, 95% CI: 0.29-0.83), husband/partner having completed secondary or higher education (OR: 2.18, 95% CI: 1.48-3.22), being in the richest wealth quintile, and four other factors were found to be significantly associated with the assistance of skilled birth attendants. Conclusions: This research extends our knowledge on the determinants of safe delivery among women in the eastern part of Indonesia. This study revealed that the economic status of household remains an important issue in improving safe delivery among women in eastern part of Indonesia. An open innovation and partnership process to improve safe delivery program that engages the full range of stakeholders should be developed based on economic situation.

Sexual Relationship Power and Socio-demographic Factors Predicting Contraceptive Use, Antenatal Visits and Sick Child Health Service Use in Northern Togo

INTRODUCTION

Implementation of community-based healthcare services offering effective contraception, antenatal care (ANC), and treatment for symptomatic children under five has reduced maternal and child mortality in Togo. However, understanding if women are utilizing these services differentially based on social or demographic factors is important. This study identifies whether sexual relationship and socio-demographic factors are associated with healthcare utilization in four health facility catchment areas.

METHODS

We conducted a cross-sectional household survey of women aged 15-49 in four health facility catchment areas in 2016 (three rural sites, one urban site). We used multivariable Poisson regression to test whether socio-demographic factors and a validated sexual relationship power scale were associated with contraceptive use, ANC visits, and seeking treatment for symptomatic children under five.

RESULTS

Among women not pregnant or desiring pregnancy, older age, lower education, and single relationship status were associated with lower use of effective contraception. Among women who gave birth in two years preceding survey, low relationship power and low wealth quintile were associated with being less likely to attend at least four ANC visits. Women in rural sites were slightly more likely than women in the urban site to report seeking treatment for child under five with malaria, pneumonia, and/or diarrhea symptoms in last 2 weeks.

DISCUSSION

Interventions in low-resource settings should explore ways to reach women with low health-service utilization to improve contraceptive use, ANC visits, and treatment for sick children. Furthermore, age, education, marital status, wealth status and sexual relationship power must be considered when targeting maternal health behaviors.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03773913; Date of registration: 12 Dec. 2018.

Sexual Relationship Power and Socio-demographic Factors Predicting Contraceptive Use, Antenatal Visits and Sick Child Health Service Use in Northern Togo

INTRODUCTION

Implementation of community-based healthcare services offering effective contraception, antenatal care (ANC), and treatment for symptomatic children under five has reduced maternal and child mortality in Togo. However, understanding if women are utilizing these services differentially based on social or demographic factors is important. This study identifies whether sexual relationship and socio-demographic factors are associated with healthcare utilization in four health facility catchment areas.

METHODS

We conducted a cross-sectional household survey of women aged 15-49 in four health facility catchment areas in 2016 (three rural sites, one urban site). We used multivariable Poisson regression to test whether socio-demographic factors and a validated sexual relationship power scale were associated with contraceptive use, ANC visits, and seeking treatment for symptomatic children under five.

RESULTS

Among women not pregnant or desiring pregnancy, older age, lower education, and single relationship status were associated with lower use of effective contraception. Among women who gave birth in two years preceding survey, low relationship power and low wealth quintile were associated with being less likely to attend at least four ANC visits. Women in rural sites were slightly more likely than women in the urban site to report seeking treatment for child under five with malaria, pneumonia, and/or diarrhea symptoms in last 2 weeks.

DISCUSSION

Interventions in low-resource settings should explore ways to reach women with low health-service utilization to improve contraceptive use, ANC visits, and treatment for sick children. Furthermore, age, education, marital status, wealth status and sexual relationship power must be considered when targeting maternal health behaviors.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03773913; Date of registration: 12 Dec. 2018.

Factors associated with postnatal care utilization among postpartum women in Ethiopia: a multi-level analysis of the 2016 Ethiopia demographic and health survey

BACKGROUND

Most postpartum women and newborns do not utilize postnatal care due to less emphasis given especially in developing countries. Understanding individual and community-level factors associated with postnatal care will help to design appropriate strategies and policies for improving service utilization. Therefore, this study aimed to assess individual and community-level factors associated with postnatal care utilization in Ethiopia.

METHOD

This study used the Ethiopian Demographic and Health Survey (EDHS) data of 2016. A total of 4489 women who gave birth 2 years before the survey were included. Two-stage stratified cluster sampling technique was used. The analysis was done using Stata version 14.0 after checking for basic assumptions of multilevel logistic regression. Multilevel mixed-effects logistic regression was used to identify determinants of postnatal care utilization. An adjusted odds ratio with a 95% confidence interval was used to show the strength and direction of the association.

RESULTS

Husband with secondary education [AOR = 0.17, 95% CI = (0.04, 0.68)], four or more antenatal care visit [AOR = 10.77, 95% CI = (2.65, 43.70)], middle wealth quintile [AOR = 3.10, 95% CI = (1.12, 8.58)] were individual level factors. Community level education [AOR = 2.53, 95% CI = (1.06, 6.06)] and community level of health service utilization [AOR = 2.32, 95% CI = (1.14, 4.73)] were the predictors at community level.

CONCLUSION

Wealth index, number of antenatal care visits, husband education, community level of education and health service utilization were significantly associated with PNC service utilization. Provision of quality antenatal care, improvement of the educational status of women and husband involvement in PNC are important strategies to increase PNC service utilization.

Uptake of Skilled Maternal Healthcare in Ethiopia: A Positive Deviance Approach

Risk factor approaches are often used when implementing programs aimed at enforcing advantageous health care behaviors. A less frequently-used strategy is to identify and capitalize on those who, despite risk factors, exhibit positive behaviors. The aim of our study was to identify positive deviant (PD) mothers for the uptake of skilled maternal services and to explore their characteristics. Data for the study came from two waves of the Ethiopian Demographic and Health Surveys conducted in 2011 and in 2016. PD mothers were defined as those reporting no formal education but with adequate use of antenatal care (ANC) and/or institutional delivery services. Two-level multilevel regression analysis was used to analyze the data. Factors associated with PD for the use of ANC services were: partner's education status, involvement in household decision making, exposure to media, and distance to the health facility. Factors associated with PD for health facility delivery were: partner's education, woman's employment status, ANC visit during index pregnancy, exposure to media, and perceived challenge to reach health facility. Rural-urban and time-related differences were also identified. The positive deviance approach provides a means for local policy makers and program managers to identify factors facilitating improved health behaviour and ultimately better health outcomes while acknowledging adverse risk profiles.

Multilevel Factors Associated With Pregnancy-Related Health Behaviors in Indonesia: Evidence From the 2007, 2012, and 2017 Indonesian Demographic Health Surveys

This study attempted to examine individual- and community-level factors that contribute to pregnancy-related health behaviors among Indonesian women. This study used representative nationwide survey samples from the Indonesian Demographic Health Survey in the years 2007 (N = 15 193), 2012 (N = 14 431), and 2017 (N = 14 797). Generalized linear mixed models were constructed in the multivariate analyses. We found that women’s educational level, household wealth index, insurance status, access to health facilities, geographic location, general health condition, and pregnancy intentions were significantly associated with different outcome behaviors. Regarding community-level influences, women who lived in communities with a high proportion of educated women and high household wealth were more likely to have skilled birth attendance during childbirth compared with their counterparts in 2007. The similar pattern of results was also found in 2012 and 2017. The findings of this study suggest that future policies should focus on both individual- and community-level factors to improve women’s pregnancy-related behaviors.

Multilevel Factors Associated With Pregnancy-Related Health Behaviors in Indonesia: Evidence From the 2007, 2012, and 2017 Indonesian Demographic Health Surveys

Indonesia has one of the highest maternal mortality rates among Southeast Asia countries. Mothers' pregnancy-related behaviors were proven to be the major determinants of maternal mortality. This study attempted to measure individual- and community-level factors that contribute to pregnancy-related health behaviors among Indonesian women. This study used representative nationwide survey samples among women aged 15 to 49 years from the Indonesian Demographic Health Survey in the years 2007 (N = 15 314), 2012 (N = 15 197), and 2017 (N = 15 300). Generalized linear mixed models were constructed to simultaneously analyze relationships of pregnancy-related health behaviors with other individual- and community-level explanatory factors. We found that women's educational level, household wealth index, insurance status, access to health facilities, geographic location, general health condition, pregnancy intentions, and community-level socioeconomic status were significantly associated with different outcome behaviors. The findings of this study suggest that future policies should focus on both individual- and community-level factors to improve women's pregnancy-related behaviors.

Determinants of maternal healthcare utilization among married adolescents: Evidence from 13 Sub-Saharan African countries

OBJECTIVES

Child and adolescent marriage are widely prevalent in some developing countries, and yet evidence on the maternal healthcare utilization of married adolescents is sparse. This study sought to identify the determinants of maternal healthcare utilization among married adolescents in 13 countries with the highest adolescent marriage rates in Sub-Saharan Africa.

STUDY DESIGN

This is a multicountry cross-sectional analysis.

METHODS

Demographic and Health Survey data on 4288 married adolescents were used. Multivariable logistic regressions were used to identify the individual- and household-level predictors of the utilization of antenatal care, safe delivery and postnatal care.

RESULTS

Wealth and access to media were positively associated with the utilization of all types of maternal healthcare services. Female education and partner education were positively associated with antenatal care. Predictors of safe delivery included urban residence (odds ratio [OR] = 1.87; 95% confidence interval [CI] = 1.15-3.03), female education (OR = 1.37; 95% CI = 1.16-1.60) and number of living children (OR = 1.25; 95% CI = 1.01,1.54), whereas positive correlates of postnatal care were urban residence (OR = 1.35; 95% CI = 1.00-1.82), partner education (OR = 1.32; 95% CI = 1.12-1.56) and employment (OR = 1.43; 95% CI = 1.07,1.89). Full antenatal care and safe delivery utilization were associated with increased postnatal care utilization. Second or third birth order and associated birth intervals were strong barriers to maternal healthcare utilization. Although autonomy in decision-making over financial spending and relationships were positively associated with full antenatal care (OR = 1.09; 95% CI = 1.03-1.14), the results suggest that autonomy over personal healthcare decisions had an opposite relationship (OR = 0.76; 95% CI = 0.58-1.01).

CONCLUSIONS

Living conditions and autonomy in decision-making over resources and relationships are facilitators of maternal healthcare utilization among married adolescents. Determinants observed in this multicountry study can help shape maternal healthcare interventions in context with high child and teenage marriage rates.

Patient preferences for prenatal testing and termination of pregnancy for congenital anomalies and genetic diseases in Ethiopia

OBJECTIVE

As prenatal diagnostic services expand throughout low-income countries, an important consideration is the appropriateness of these services for patients. In these countries, services now include prenatal ultrasound and occasionally genetic testing. To assess patient interest, we surveyed pregnant patients at a hospital in Addis Ababa, Ethiopia, on their preferences for prenatal testing and termination of affected pregnancies for congenital anomalies and genetic diseases.

METHOD

One hundred one pregnant patients were surveyed on their preferences for prenatal testing and termination of affected pregnancies using a survey covering various congenital anomalies and genetic diseases.

RESULTS

Eighty-nine percent of patients reported interest in testing for all conditions. Three percent of patients were not interested in any testing. Over 60% of patients reported interest in termination for anencephaly, early infant death, severe intellectual disability, hemoglobinopathy, and amelia. Patients were more likely to express interest in prenatal testing and termination for conditions associated with a shortened lifespan.

CONCLUSION

Ethiopian patients were interested in prenatal testing and termination of pregnancy for many conditions. Advancing prenatal diagnostic capacities is a potential strategy for addressing the incidence of congenital anomalies and genetic disease in Ethiopia. Importantly, there exist many factors and technological limitations to consider before implementation.

Factors affecting utilization of antenatal care in Ethiopia: A systematic review and meta-analysis

Background

In the context of high maternal morbidity and mortality in Sub-Saharan Africa, less than 80% of pregnant women receive antenatal care services. According to a 2016 national report, only 62% of pregnant women in Ethiopia made at least one antenatal care visit. The aim of this review was to systematically and quantitatively summarize the factors affecting utilization of antenatal care in Ethiopia.

Methods

We searched PubMed, Medline, EMBASE, CINAHL, Google Scholar and Maternity and Infant Care database for studies that had been conducted in Ethiopia between 2002 and 2016. We summarized the studies on the use of antenatal care services quantitatively and qualitatively. A random-effects model was conducted to obtain the pooled estimates.

Results

A total of fifteen observational studies were included in this review. The pooled prevalence of utilization of antenatal care services in Ethiopia was 63.77% (95CI 53.84–75.54). The pooled odds ratio showed that a significant positive association was found between utilization of antenatal care and urban residence (OR = 1.92, 95%CI = 1.35–2.72), women’s education (OR = 1.90, 95%CI = 1.52–2.37), husband’s education (OR = 1.49, 95%CI = 1.32–1.69) and planned pregnancy (OR = 2.08, 95%CI = 1.45–2.98). Based on narrative synthesis exposure to mass media, family income and accessibility of the service were strongly associated with utilization of antenatal care.

Conclusion

The findings of this review found several modifiable factors such as empowering women through education and increasing their decision-making power, promoting family planning to prevent unplanned pregnancy, increasing awareness of women through mass media and making services more accessible would likely to increase utilization of antenatal care. Further research is needed on accessibility and availability of the service at the individual and community level to assess the predictors of antenatal care service utilization.

The Role of Women's Autonomy and Experience of Intimate Partner Violence as a Predictor of Maternal Healthcare Service Utilization in Nepal

This study aims to identify the relationship of women’s autonomy and intimate partner violence (IPV) with maternal healthcare service utilization among married women of reproductive age in Nepal. This study used data from the 2016 Nepal Demographic and Health Survey (NDHS), which is a nationally representative sample survey. The association between outcome variables with selected factors were examined by using the Chi-square test (χ²), followed by multiple logistic regression. The sample was adjusted for multi-stage sampling design, cluster weight, and sample weight. Of the total sample, 68.4% reported attending sufficient Antenatal care (ANC) visits throughout their pregnancy, while 59.9% reported having a health facility delivery. The factors associated with both, sufficient ANC visits and institutional delivery includes ethnicity, place of residence, household wealth status, and the number of living children. Women who have access to media, and who have intended pregnancy were more likely to have sufficient ANC visits. Exposure to some forms of violence was found to be the barrier for maternal health service utilization. Attending ANC visits enables mothers to make the decision regarding skilled attendance or health facility delivery. Preventing any forms of violence need to be considered as a vital element in interventions aimed at increasing maternal health service utilization.

A comparative study of the prevalence of and factors associated with insecticide-treated nets usage among children under 5 years of age in households that already own nets in Malawi

Background

Despite malaria control programmes having successfully increased the number of households owning insecticide-treated nets (ITNs) in Malawi, the population of people with ITN access but still not using them fluctuated from 13% in 2010, 5% in 2012 and then 12% in 2015. This study aimed to compare the rate and factors associated with ITN usage among children under 5 years of age, living in household with at least one ITN, in Malawi between 2010 and 2015.

Methods

The 2010 and 2015–2016 Malawi Demographic and Health Surveys (MDHSs) were utilized. Only children from households that owned at least one ITN were selected. Multivariate logistic regression analyses were performed to examine associations of child, maternal and household factors with ITN usage.

Results

In total, 12,378 and 10,196 children under 5 years of age were examined from 2010 and 2015–2016, respectively. ITN usage increased from 57.8% (95% Confidence interval (CI): 56.1%–59.4%) in 2010 to 69.0% (95% CI 67.4%–70.5%) in 2015. The multivariate analysis revealed that, among others, being aged ≥ 24 months, having mothers with no formal education or with primary education, residing in a female-headed household, and residing in households that had poor household ITN supply were significantly associated with reduced odds of ITN usage.

Conclusions

ITNs are a key vector control intervention in malaria prevention. This study revealed increased ITN usage among children under 5 years old in the 5-year period, suggesting that considerable improvements have been made. However, continued efforts to increase awareness of the importance of using ITNs in malaria prevention in Malawi are necessary. Findings from this research provide some policy implications, especially for improving household ITN supply, to improve ITN utilization in Malawi.

Decision Making Autonomy and Maternal Healthcare Utilization among Nigerian Women

BACKGROUND AND OBJECTIVES

Low assess to ante-natal care (ANC) services continue to pose a major public health challenge leading to high maternal mortality rates in developing countries. Non-utilization of ANC services among about a quarter of Nigerian women of reproductive age remains a major concern in the actualization of Sustainable Development Goals. Considering the complexity of healthcare utilization in Nigeria, the relationship between a particular health care utilization pattern and women autonomy has not been fully examined. This study examines the patterns of women autonomy and their relationships with ANC utilization in Nigeria.

METHODS

This was a cross-sectional analysis of the 2013 nationally representative data from the Nigerian Demographic and Health Survey (NDHS). Factor analysis/score were used to construct women autonomy index, while chi-square and logistic regression were used to establish the relationships between the response and exposure variables.

RESULTS

There is a strong relationship between women decision making autonomy status and ANC services among Nigeria women. The odds of utilizing ANC services among women with more decision making autonomy were significantly 3.79 higher than among women with low decision-making autonomy. The use of ANC increases as age, education and wealth status of respondents increase.

CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS

These results indicate that women autonomy is undoubtedly a major determinant of ANC utilization in Nigeria.

Assessing the link between endorsing attitudes justifying partner abuse and reproductive health care utilization among women in Lao PDR

Objective: Evidence from developing countries on the association between women's endorsement of attitudes justifying partner abuse and their use of reproductive health services is suggestive but inconclusive. This study uses a nationally representative dataset from Lao PDR to provide strong evidence for the relationship between women's endorsement of attitudes justifying partner abuse and use of reproductive health services. Methods: This study used data from the 2011-2012 Lao Social Indicator survey (LSIS). The analyses were performed on the responses of 4227 women. The exposure of interest in this study was endorsement of attitudes justifying partner abuse. Antenatal care (ANC) visits divided according to amount and quality, delivery care by type and place, and utilization of postnatal care (PNC) for mothers and newborn infants were used as representative outcome variables of reproductive health service utilization. Results: Approximately seven out of ten respondents (67.9%) believed that partner abuse was justified. Women who endorsed these attitudes were significantly less likely to receive any ANC, to seek institutional delivery, and to use trained medical personnel for delivery assistance. Endorsing attitudes were associated with reduced probability of receiving PNC services for mothers and newborn infants, reduced frequency of ANC visits, and receiving a fewer number of ANC components. Other sociodemographic factors likely to affect the increased utilization of several of the indicators of reproductive health care were living in the central region, belonging to the high bands of wealth, having higher level of education, being a young adult (20-34 years) or older (35-49 years), residing in urban areas, and being sexually empowered. Conclusions: In addition to a broad range of sociodemographic factors, our findings suggested that women's endorsement of attitudes justifying partner abuse should be treated as an important psychosocial determinant of reproductive health care service utilization in Lao PDR.

Factors associated with insecticide-treated net usage among women of childbearing age in Malawi: a multilevel analysis

Background

This study aimed to identify factors at individual and community level influencing insecticide-treated net (ITN) usage among groups of women of childbearing age (WOCBA) in Malawi.

Methods

Factors influencing ITN usage in Malawi were assessed through interviews with 16,130 WOCBA (15–49 years) across 850 communities who participated in the 2015–2016 Malawi Demographic Health Survey. Multilevel logistic regression analysis was used.

Results

ITN use was similar between pregnant women and non-pregnant women with children under 5 years (45.9% and 46.9%, respectively), but slightly lower among non-pregnant women without children under 5 years (39.1%). Both individual and community characteristics were associated with ITN use among WOCBA and varied significantly across subgroups. Specifically, non-pregnant women with children under 5 years living in communities where women had high autonomy in health care decisions had an 18% greater odds of using an ITN compared with those from communities where women had low health care autonomy (adjusted odds ratio [aOR] = 1.18; 95% confidence interval [CI] 1.00–1.38). Distance to health care facility influenced ITN usage among pregnant women; those who did not regard distance as a problem had a 44% greater odds of using an ITN than those for whom distance was seen as a problem (aOR = 1.44; 95% CI 1.09–1.89). Number of household members, region, urbanization, and community ITN coverage influenced ITN usage across all WOCBA groups.

Conclusion

The findings confirmed the importance of assessing various factors affecting ITN usage among groups of WOCBA. Both individual- and community-level factors should be considered when designing and implementing ITN programmes in Malawi.