Maternal Decision-Making Input and Health-Seeking Behaviors Between Pregnancy and the Child's Second Birthday: A Cross-Sectional Study in Nepal

Cash transfer, maternal and child health outcomes: a scoping review in sub-Saharan Africa

BACKGROUND

Cash Transfer (CT) programmes can improve maternal and child health outcomes in low- and middle-income countries. However, studies assessing the effectiveness of these programmes on maternal and child health outcomes (MCH), beyond nutritional outcomes and service utilisation, remain inconclusive.

OBJECTIVES

We synthesized current empirical evidence on the effectiveness of these programmes in improving MCH outcomes and suggested a framework for reporting such outcomes. We focused on sub-Saharan Africa because of substantial operational differences between regions, and the need for MCH advancement in this region.

METHODS

This review searched PubMed Central and Google Scholar and supplemented it with a backward citation search for studies conducted in sub-Saharan Africa for the period between 2000 and 2021. Only peer-reviewed studies on CT that reported health outcomes beyond nutritional outcomes and service utilisation among women of reproductive age and children below 18 years old were included.

RESULTS

Twenty-one articles reporting studies conducted in six sub-Saharan African countries were identified. All studies reported health outcome measures, and programmes targeted women of reproductive age and children under 18 years of age. Of the 21 articles, 1 reported measures of mortality, 13 reported measures of functional status; 3 reported subjective measures of well-being, and 4 reported behavioural health outcomes. Across all categories of reported measures, evidence emerges that cash transfer programmes improved some health outcomes (e.g. improved infant and child survival, reduced incidence of illnesses, improved cognitive and motor development, improved general health, delayed sexual debut, lower transactional sex, etc.), while in some of the studies, outcomes such as depression did not show significant improvements.

CONCLUSION

Cash Transfer programmes are effective and cost-effective, with a real potential to improve maternal and child health outcomes in sub-Saharan African countries. However, further research is needed to address implementation challenges, which include data collection, and programme management.

Geospatial Analysis of Parental Healthcare-Seeking Behavior in the Vicinity of Multispecialty Hospital in India

Background and Objective

The healthcare-seeking behavior of vulnerable groups, such as children under five, depends on a multitude of factors, including the caregiver's decision making. Approximately 60% of Indians seek care from private hospitals. Recent health policy in India has favored the establishment of multispecialty hospitals. However, it remains unclear to what extent this policy has changed the number of Indians seeking healthcare from these government-established multispecialty hospitals. The study aims to assess the health-seeking behavior of parents of children under five in the vicinity of a public multispecialty tertiary care hospital.

Methods

This was a community-based cross-sectional survey with geospatial mapping conducted among the parents of children under five using a semi-structured questionnaire in Epi-collect mobile app. The study site was an urban slum in a catchment area [within five kilometers (km)] of a multispecialty tertiary care public hospital in the central Indian state of Chhattisgarh. The study was conducted for one year duration from February 2019 to January 2020. A questionnaire was administered to the parents of the children under five (N = 353) after their household confirmation from the nearby Anganwadi center, the community level service providing center under the Integrated Child Development Scheme by the Ministry of Women and Child Development (WCD). The questionnaire included sections for demographic characteristics, the illness pattern among their children, health-seeking decision-making, and more. Descriptive analysis was presented with numbers and percentages. Univariate analysis was used to assess the association between sociodemographic variables and health-seeking characteristics. Statistical significance was considered at p value less than 0.05. We used geospatial mapping using coordinates collected and compiled using the Microsoft Excel version 2021 and analyzed using QGIS (Quantum Geographic Information System) software.

Results

Among the parents interviewed patients (N = 353), maternal literacy rates were over 85%. Approximately 54% of the families were below poverty line. Among 95.2% of the families, mothers were part of decision-making regarding their children's health-seeking. Over 92% of the families opted for consultation in a nearby private hospital or dispensary. Geospatial mapping of private hospitals was a favored place for healthcare-seeking by mothers, irrespective of their socioeconomic status or education rather than multispecialty hospital.

Conclusion and Global Health Implications

The majority of the parents in the vicinity of public multispecialty hospitals seek care from private clinics for ailments for children under five. The establishment of public multispecialty tertiary care hospitals, which are mandated for tertiary level of care and research, cannot replace primary-level healthcare institutions, showed that private hospitals were the favored places healthcare seeking by mothers. These primary-level institutions are critical for the management of common ailments for children under five near home and reducing the financial burden on the family, even in the vicinity of a multispecialty hospital.

High-risk fertility behaviours among women in sub-Saharan Africa

BACKGROUND

High-risk fertility behaviours such as too early or advanced age at delivery, shorter birth interval, birth order and a higher number of live births to a woman often lead to adverse maternal and child health outcomes. We assessed high-risk fertility behaviours and their associated factors among women in sub-Saharan Africa (SSA).

METHODS

Data on 200 716 women pooled from the demographic and health surveys of 27 countries conducted between 2010 and 2020 in SSA were analysed. High-risk fertility behaviour from four indicators, mother aged <18 years at the time of delivery; mother aged >34 years at the time of delivery; mother of a child born after a short birth interval (<24 months) and mother of high parity (>3 children), was derived. Multi-level multi-variable logistic regression analyses were carried out and the results were presented as adjusted odds ratios at 95% confidence interval.

RESULTS

Women who were in polygamous marriages had higher odds of single and multiple high-risk fertility behaviour compared with their counterparts who were in monogamous marriages. Women with middle or high maternal decision-making power had higher odds of single and multiple high-risk fertility behaviours compared with those with low decision-making power. Single and multiple high-risk fertility behaviours were lower among women with access to family planning, those with at least primary education and those whose partners had at least primary education compared with their counterparts who had no access to family planning, those with no formal education and those whose partners had no formal education.

CONCLUSION

Family structure, women's decision-making power, access to family planning, women's level of education and partners' level of education were identified as predictors of high-risk fertility behaviours in SSA. These findings are crucial in addressing maternal health and fertility challenges. Policy makers, maternal health and fertility stakeholders in countries with high prevalence of high parity and short birth intervals should organize programs that will help to reduce the prevalence of these high-risk factors, taking into consideration the factors that predispose women to high-risk fertility behaviours.

Determinants of recommended antenatal care visits among pregnant women in Ethiopia: a generalized linear mixed-effects modeling

BACKGROUND

Although antenatal care has the potential role to reduce maternal and child morbidity and mortality, utilization of a recommended number of antenatal care visits is still low in Ethiopia. Therefore, this study aimed to assess the determinants of recommended antenatal care visits in Ethiopia.

METHOD

Data from the 2019 mini-Ethiopian demographic and health survey (MEDHS) was used for this study. A total of 3916 women who gave birth 5 years preceding the MEDHS were included. A generalized linear mixed-effects (mixed-effects logistic regression) model was used to identify the determinants of recommended antenatal care service utilization. Finally, the adjusted odds ratio with a 95% confidence interval and random effects were reported.

RESULTS

In the generalized linear mixed-effects model, women with primary education (AOR = 1.55, 95%CI 1.22-2.01), secondary and above education (AOR = 5.12, 95%CI 2.80-8.16), women from the middle (AOR = 1.25, 95%CI 1.01-1.71) and rich wealth index (AOR = 1.54, 95%CI 1.12-2.25), women who were exposed to media (AOR = 1.23,95%CI 1.01-1.57) and who use contraception (AOR = 1.45 95%CI 1.25-2.03), had higher odds of recommended antenatal care service utilization.

CONCLUSION

In this study, factors like maternal educational status, media exposure, wealth index and history of contraceptive utilization were significantly associated with recommended ANC visits in Ethiopia. Therefore, encouraging women for contraceptive service utilization, consulting women to be exposed to media and improving women's wealth status will help to have recommended number of ANC visits by pregnant women in Ethiopia.

Growth monitoring service utilization and its associated factors among mothers of children less than 2 years in Muhir Aklil district, Gurage zone, Southern Ethiopia, 2020

INTRODUCTION

United Nations International Children's Emergency Fund recommends a 100% growth monitoring and promotion coverage, but the prevalence of growth monitoring and promotion service utilization rate in Ethiopia is only 16.9%. Even though Ethiopia is attempting different strategies to cope up with this low rate, the problem is still unresolved.

OBJECTIVE

The aim of this study is to assess the prevalence of growth monitoring service utilization and its associated factors among mothers of children less than 2 years in Muhir Aklil district.

METHODS

A community-based cross-sectional study was conducted on 443 study participants from 10 February to 8 March 2020. The study participants in the study were selected using simple random sampling technique. The collected data were entered in to EpiData3.1 and exported to SPSS version 23. Bivariate and multi-variable logistic regression analysis was used to identify factors associated with growth monitoring service utilization. Statistically significance was declared at p value < 0.05% and 95% confidence interval.

RESULTS

In this study, the overall growth monitoring and service utilization was 32.9%. Fully empowered mothers adjusted odds ratio: 2.7, 95% confidence interval: 1.5-4.3), receiving counseling (adjusted odds ratio: 2.8; 95% confidence interval: 2.0-4.7) and regularly participating on community conversation (adjusted odds ratio: 2.8, 95% confidence interval: 1.8-7.6) were significantly associated with growth monitoring service utilization.

CONCLUSION

Growth monitoring services utilization was 32.9%. Maternal empowerment on decision-making, engaging women on financial control, knowledge of mothers receiving counseling and regularly participating on community conversation were the independent factors for growth monitoring service utilization. The health extension workers should strengthen maternal empowerment and community conversation through increasing maternal awareness.

Women's involvement in decision-making and receiving husbands' support for their reproductive healthcare: a cross-sectional study in Lalitpur, Nepal

BACKGROUND

Sociocultural factors remain an important determinant for women's involvement with decision making and getting husbands' support for their reproductive healthcare. Therefore this study was conducted to examine sociodemographic factors associated with women's involvement in decision making and getting husbands' support for their reproductive healthcare.

METHODS

An institutional-based cross-sectional study was conducted in Lalitpur, Nepal. A total of 600 respondents were selected from 15 immunization clinics. Participants were women ≥18 y of age who came to the child's immunization clinic. The association between sociodemographic variables and women's involvement in decision making and getting husbands' support for their reproductive healthcare was analysed through multivariate logistic regression models.

RESULTS

While women's involvement in decision making was greater for childcare, it was less in the area related to financial matters. In contrast, husbands supported more in the area related to finances than for childcare and accompanying to health facilities. The significant determinants for women's involvement in decision making and getting husbands' support were the woman's caste, education level, employment status, household income, age group and number of children. Madhesi/Muslim/other women were less likely (adjusted odds ratio [AOR] 0.31 [95% confidence interval {CI} 0.12 to 0.73]) to decide the number of babies and birth spacing. These women were also less likely (AOR 0.18 [95% CI 0.02 to 0.86]) to be accompanied by their husbands to the family planning (FP) clinic. Janajati, Dalit and Madhesi/Muslim/other women were less likely to receive their husbands' support for birth preparedness. Women who were <20 y of age and had a single child were less likely to get involved in decision making and getting their husbands' support for FP services.

CONCLUSIONS

The findings call for reproductive health programs that encourage women's involvement in decision making and receiving husbands' support in women's reproductive healthcare. When designing such a program in the FP area, the woman's caste, age and parity should be given special consideration. Also, caste should be considered when designing such a program related to birth preparedness.