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Tolossa T, Gold L, Dheresa M, Turi E, Yeshitila YG, Abimanyi-Ochom J. Adolescent maternal health services utilization and associated barriers in Sub-Saharan Africa: A comprehensive systematic review and meta-analysis before and during the sustainable development goals. Heliyon 2024; 10:e35629. [PMID: 39170315 PMCID: PMC11336889 DOI: 10.1016/j.heliyon.2024.e35629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 08/23/2024] Open
Abstract
Introduction Effective and adequate maternal health service utilization is critical for improving maternal and newborn health, reducing maternal and perinatal mortality, and important to achieve global sustainable development goals (SDGs). The purpose of this systematic review was to assess adolescent maternal health service utilization and its barriers before and during SDG era in Sub-Saharan Africa (SSA). Methods Systematic review of published articles, sourced from multiple electronic databases such as Medline, PubMed, Scopus, Embase, CINAHL, PsycINFO, Web of Science, African Journal Online (AJOL) and Google Scholar were conducted up to January 2024. Assessment of risk of bias in the individual studies were undertaken using the Johanna Briggs Institute (JBI) quality assessment tool. The maternal health service utilization of adolescent women was compared before and after adoption of SDGs. Barriers of maternal health service utilization was synthesized using Andersen's health-seeking model. Meta-analysis was carried out using the STATA version 17 software. Results Thirty-eight studies from 15 SSA countries were included in the review. Before adoption of SDGs, 38.2 % (95 % CI: 28.5 %, 47.9 %) adolescents utilized full antenatal care (ANC) and 44.9 % (95%CI: 26.2, 63.6 %) were attended by skilled birth attendants (SBA). During SDGs, 42.6 % (95 % CI: 32.4 %, 52.8 %) of adolescents utilized full ANC and 53.0 % (95 % CI: 40.6 %, 65.5 %) were attended by SBAs. Furthermore, this review found that adolescent women's utilization of maternal health services is influenced by various barriers, including predisposing, enabling, need, and contextual factors. Conclusions There was a modest rise in the utilization of ANC services and SBA from the pre-SDG era to the SDG era. However, the level of maternal health service utilization by adolescent women remains low, with significant disparities across SSA regions and multiple barriers to access services. These findings indicate the importance of developing context-specific interventions that target adolescent women to achieve SDG3 by the year 2030.
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Affiliation(s)
- Tadesse Tolossa
- Department of Public Health, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
- Deakin University, Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Geelong, 3220, Australia
| | - Lisa Gold
- Deakin University, Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Geelong, 3220, Australia
| | - Merga Dheresa
- Haramaya University, College of Health and Medical Sciences, Department of Nursing and Midwifery, Harar, Ethiopia
| | - Ebisa Turi
- Department of Public Health, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
- Deakin University, Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Geelong, 3220, Australia
| | - Yordanos Gizachew Yeshitila
- Deakin University, Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Geelong, 3220, Australia
- School of Nursing, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Julie Abimanyi-Ochom
- Deakin University, Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Geelong, 3220, Australia
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Mahamud Tohan M, Islam MA, Rahman MA. Exploring the factors behind socioeconomic inequalities in Antenatal Care (ANC) utilization across five South Asian natiaons: A decomposition approach. PLoS One 2024; 19:e0304648. [PMID: 39110696 PMCID: PMC11305544 DOI: 10.1371/journal.pone.0304648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 05/16/2024] [Indexed: 08/10/2024] Open
Abstract
Maternal and child mortality rates remain a significant concern in South Asian countries, primarily due to limited access to maternal care services and socioeconomic disparities. While previous studies have examined the factors influencing the utilization of antenatal care (ANC) services in individual countries, there is a lack of comparative analysis across South Asian nations. This study aims to investigate the factors affecting ANC utilization among women aged 15-49 in Bangladesh, India, Nepal, Maldives, and Pakistan using the latest Demographic and Health Survey data. The study utilized a total weighted sample size of 262,531 women. Simple bivariate statistics and binary logistic regression were employed to identify potential factors influencing ANC utilization. Decomposition analysis and concentration curve (Lorenz curve) were used to assess inequality in ANC service utilization. The prevalence of ANC utilization varied across the countries, with Maldives having the highest (96.83%) and Bangladesh the lowest (47.01%). Women's and husbands' education, household wealth status, BMI, and urban residence were found to significantly influence maternal healthcare services utilization. Higher education levels, affluent wealth quintiles, and urban living were identified as significant contributors to socioeconomic disparities in accessing ANC services. This study highlights the crucial role of socioeconomic factors in the utilization of maternal healthcare services in South Asian countries. Governments should focus on improving healthcare infrastructure, addressing cultural barriers, and promoting education to address these disparities. Identifying context-specific causes of maternal healthcare utilization is essential to inform targeted interventions and policies aimed at improving access to ANC services and reducing maternal mortality rates.
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Affiliation(s)
- Mortuja Mahamud Tohan
- Development Studies Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - Md. Amirul Islam
- Development Studies Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - Md. Ashfikur Rahman
- Development Studies Discipline, Social Science School, Khulna University, Khulna, Bangladesh
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Pandey BW, Yadav G, Tripathi N, Pathak PK. Reproductive and child health transition among selected empowered action groups states of India: A district-level analysis. PLoS One 2024; 19:e0301587. [PMID: 38857210 PMCID: PMC11164384 DOI: 10.1371/journal.pone.0301587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 03/19/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Health is an inseparable part of life and central to all life supporting systems. The reproductive and child health shares a major portion of public health cases that is crucial for socio-economic development. Studies on reproductive and child health have traditionally been focused on demographic aspects using socio-economic parameters. Given the emphasis of Sustainable Development Goal (SDG)-3 on health and well-being, it is imperative to understand the geo-spatial dimension with the visible transition of key health indicators of fertility, maternal and infant/child health in the high burdened districts within these high focus Empowered Action Group (EAG) states of Rajasthan, Madhya Pradesh, Uttar Pradesh and Bihar that make up nearly 40% of India's population with relatively laggard health status. METHODOLOGY This paper aims to understand the status and trend of key reproductive and child health indicators and vital statistics based on the recent representative demographic surveys. We intend to undertake a district level spatio-temporal analysis by developing District Composite Health Profile (DCHP) using Composite Index Method on selected 13 equally weighted key reproductive and child health indicators. The study has been carried out using data from National Family Health Survey-4 (2015-16) and National Family Health Survey-5 (2019-21) survey rounds. We employed geo-spatial techniques i.e. Moran's-I, and univariate LISA to comprehend the geographical clustering of high and low health burden districts and their heterogeneities at the district level. RESULTS/CONCLUSIONS The study highlights emerging inter-districts, and inter-state disparities over survey periods. With consistent improvement in the selected EAG states over time, the overall reproductive and child health status through DCHP along with each indicator was relatively better in the states of Rajasthan and worse in Bihar. Districts along the Terai belt in Uttar Pradesh and Bihar consistently performed sluggish during survey rounds. The geo-spatial clustering follows the political boundary of states, albeit with intra-state variations. Monitoring of key health indicators using composite index method provides a useful leverage for identifying priority districts/regions for universal health access that should also consider geographical space as an important policy dimension.
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Affiliation(s)
- Bindhy Wasini Pandey
- Department of Geography, Delhi School of Economics, University of Delhi, New Delhi, India
| | - Ganesh Yadav
- Department of Geography, Kalindi College, University of Delhi, New Delhi, India
| | - Niharika Tripathi
- Department of Sociology, Indraprastha College for Women, University of Delhi, New Delhi, India
| | - Praveen Kumar Pathak
- Centre for the Study of Regional Development, Jawaharlal Nehru University, New Delhi, India
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Al-Zubayer MA, Shanto HH, Kundu S, Sarder MA, Ahammed B. The level of utilization and associated factors of WHO recommended antenatal care visits in South Asian countries. DIALOGUES IN HEALTH 2024; 4:100175. [PMID: 38516215 PMCID: PMC10953919 DOI: 10.1016/j.dialog.2024.100175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/26/2024] [Accepted: 02/23/2024] [Indexed: 03/23/2024]
Abstract
Background Antenatal care can play an important role in reducing the death of both mothers and children. This study was designed to find out the determinants of world health organization recommended antenatal care visits in six South Asian countries to achieve the targets for Sustainable Development Goal. Methods This study used recent demographic and health survey data from six South Asian countries such as Afghanistan (2015), Bangladesh (2017-18), India (2015-16), Maldives (2016-17), Nepal (2016), and Pakistan (2047-18). Descriptive statistics were calculated for the distribution and prevalence of antenatal care visits. Bivariate and multivariable logistic regressions were used to investigate the influencing factors of antenatal care visits. Results 71,862 women aged 15 to 49 years were included in this study, and 46.64% (95% Confidence Interval = 45.59 - 47.69%) had world health organization recommended antenatal care visits. In the pooled data, urban women (AOR ([Adjusted Odds Ratio]=1.48; 95% CI [Confidence Interval]=1.33-1.66), richest family (AOR=1.48; 95% CI=1.25-1.76), women's higher education (AOR=3.76; 95% CI=3.33-4.25), women's partner/husband's higher education (AOR=1.69; 95% CI=1.50-1.92), 35-49 years (AOR=1.25, 95% CI=1.11-1.42), women's age at first birth >25 years (AOR=1.51, 95% CI=1.36-1.68) and fully media exposure (AOR=2.11; 95% CI=1.74-2.56) were significantly positively associated with WHO recommended antenatal care visits. Whereas, working women (AOR=0.82; 95% CI=0.76-0.88), healthcare decision maker by their husband/others (AOR=0.71, 95% CI=0.60-0.84), ≥7 children (AOR=0.59; 95% CI=0.50-0.69), and ≥7 family members (AOR=0.82; 95% CI=0.73-0.93) had significant negative effect on antenatal care visits. In country specific analysis, overall, media exposure, secondary and above education of women, ≥25 of years age at first birth, and <4 living children were the key factors of antenatal care visits. Conclusions This study reveals an overall scenario of the WHO-recommended antenatal care visit in South Asian countries, and significant factors related to ANC that we can concentrate onto improve accessibility to healthcare services and promote education and media exposure, especially for rural and less educated women, to increase the prevalence of WHO-recommended antenatal visits in South Asian countries In addition, evidence from this study can be used to assist the policymakers in planning and taking proper steps to increase WHO-recommended antenatal care visits by focusing on the related factors in South Asian countries.
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Affiliation(s)
| | | | - Subarna Kundu
- Statistics Discipline, Khulna University, Khulna-9208, Bangladesh
| | | | - Benojir Ahammed
- Statistics Discipline, Khulna University, Khulna-9208, Bangladesh
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Diamond-Smith N, Gopalakrishnan L, Leslie H, Katz E, Harper C, Weiser S, Patil SR. Life skills and reproductive health empowerment intervention for newly married women and their families to reduce unintended pregnancy in India: protocol for the TARANG cluster randomised controlled trial. BMJ Open 2024; 14:e086778. [PMID: 38688674 PMCID: PMC11086273 DOI: 10.1136/bmjopen-2024-086778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/12/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION In South Asia, younger women have high rates of unmet need for family planning and low empowerment. Life skills interventions can equip young women with agency, but the effectiveness of these interventions in reproductive and sexual autonomy and contraception has not been examined. METHODS AND ANALYSIS A two-arm, parallel, cluster randomised controlled trial will evaluate the impact of TARANG (Transforming Actions for Reaching and Nurturing Gender Equity and Empowerment), a life skills and reproductive health empowerment group-based intervention for newly married women, compared with usual services in the community in rural and tribal Rajasthan, India. TARANG will also provide light-touch sessions to husbands and mothers-in-law of newly married women. We will test the impact of TARANG in 80 village clusters among 800 eligible households comprising newly married women aged 18-25 years who are at risk of pregnancy but do not want a pregnancy within 1 year at the time of enrolment, their husbands and mothers-in-law who consent to participate. Women in the intervention villages will receive 14 sessions over a 6-month period, while husbands and mothers-in-law will receive 1 and 4 sessions (respectively) each. Three rounds of surveys will be collected over 18 months. Control villages will receive the intervention after the endline surveys. Primary outcomes include rate of unintended pregnancy and modern contraceptive use. We plan to start recruitment of participants and data collection in April 2024. We will estimate unadjusted and adjusted intention-to-treat effects using survival analysis and mixed models. ETHICS AND DISSEMINATION Study protocols have been reviewed and approved by the human subjects review boards at the University of California, San Francisco, and the Centre for Media Studies, India (IRB00006230) and ACE Independent Ethics Committee, Bangalore (NET0062022). Results will be disseminated in international peer-reviewed journals and conferences, to stakeholders including local government and non-governmental organisations, and directly to the communities and individuals that participated in the intervention. TRIAL REGISTRATION NUMBER NCT06024616.
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Affiliation(s)
| | | | - Hannah Leslie
- Global Health and Population, University of California San Francisco, San Francisco, California, USA
| | - Elizabeth Katz
- Global Center for Gender Equality, San Francisco, California, USA
| | - Cynthia Harper
- University of California San Francisco, San Francisco, California, USA
| | - Sheri Weiser
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sumeet R Patil
- Center for Causal Research and Impact Evaluation, NEERMAN, Mumbai, India
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Kuruba YP, Sinha AP, Singh A, Pradhan P, Radhika AG. Non-Medical Determinants of Access and Quality of Maternal Health Services in India-Protocol for a Scoping Review. J Obstet Gynaecol India 2024; 74:104-108. [PMID: 38707881 PMCID: PMC11065799 DOI: 10.1007/s13224-023-01892-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 10/21/2023] [Indexed: 05/07/2024] Open
Abstract
Introduction The Maternal Mortality Rate (MMR) is one of the most important health indicators of a country. In India, MMR has decline from 130 to 113 per 100,000 live births between 2014 and 2018, however, there are wide disparities in utilization of maternal health services (MHS) among different states and across different socioeconomic groups within the states. Although the government is providing MHS through various health programs in India, there are several non medical factors leading to the underutilization of MHS services. Objective To map and summarise the non-medical determinants of access and quality of MHS in India. Methods We are conducting a scoping review of the published literature from 2000 till date in databases such as PubMed, Cochrane, Science Direct and CINAHL by including eligible qualitative as well as quantitative studies conducted in India. Data extraction and analysis will be conducted through a narrative integrative synthesis approach to summarize the non-medical determinants of access and quality of MHS in India and understand their mechanisms of influence.At the third SPINE20 summit 2022 which took place in Bali, Indonesia, in August 2022, 17 associations endorsed its recommendations. Results We will summarise the non-medical determinants that influence the access and quality of MHS. Conclusion This scoping review would help to understand and summarise the existing non-medical determinants of access and quality of MHS, highlight the research gaps and suggest potential modalities for improvement of access and quality of MHS.
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Affiliation(s)
- Yamini Priyanka Kuruba
- Division of Reproductive, Child Health and Nutrition, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029 India
| | - Anju P. Sinha
- Division of Reproductive, Child Health and Nutrition, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029 India
| | - Anoop Singh
- Division of Reproductive, Child Health and Nutrition, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029 India
| | - Pranita Pradhan
- ICMR Advanced Centre for Evidence Based Child Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A. G. Radhika
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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Sharma S, Adhikari B, Pandey AR, Karki S, K. C. SP, Joshi D, Baral SC. Association between media exposure and maternal health service use in Nepal: A further analysis of Nepal Demographic and Health Survey-2022. PLoS One 2024; 19:e0297418. [PMID: 38466757 PMCID: PMC10927118 DOI: 10.1371/journal.pone.0297418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/04/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Nepal has made incremental progress in improving coverage of maternal health services leading to improved health outcomes. Government and other health sector stakeholders have consistently considered dissemination of educational messages on maternal health through mass media. However, in Nepal's context, the media's influence on the uptake of maternal health services is less known. This study examines the links between media exposure and maternal health service use in Nepal. METHOD Our analysis is based on the nationally representative Nepal Demographic and Health Survey (NDHS) 2022 data. We analyzed data from 1933 women aged 15-49 who had given birth in the two years preceding the survey. Weight analysis was performed to account for complex survey design. We presented categorical variables as frequency, percentage, and corresponding 95% Confidence Interval (CI). Univariable and multivariable logistic regression assessed the association between media exposure and maternal health service use, and the results are presented as crude (COR) and adjusted odds ratios (AOR) along with 95% CI. RESULTS Women exposed to internet use had 1.59 times [AOR = 1.59, 95% CI = 1.16, 2.19], and those exposed to radio and television health programs had 1.73 times [AOR = 1.73, 95% CI = 1.17, 2.56] higher odds of having four or more Antenatal Care (ANC) visits. Similarly, women exposed to mass media had 1.32 times [AOR = 1.32, 95% CI = 1.00, 1.74] and those exposed to health programs had 1.50 times [AOR = 1.50, 95% CI = 1.02, 2.21] higher odds of having an institutional delivery. However, mass media exposure, internet use, and health program exposure were not significantly associated with increased postnatal care of mother and newborn. CONCLUSION Exposure to health programs and internet use are positively associated with four or more ANC visits. Exposure to mass media and health programs are positively associated with increased institutional delivery. Our findings imply that well-designed campaigns and awareness programs delivered through mass media platforms play a vital role in enhancing the uptake of maternal health services.
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Pal SK, Shekhar C. Association between high-risk fertility behaviour and anaemia among urban Indian women (15-49 years). BMC Public Health 2024; 24:750. [PMID: 38461259 PMCID: PMC10924421 DOI: 10.1186/s12889-024-18254-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 03/01/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Women in their reproductive age have tremendous health implications that affect their health and well-being. Anaemia is an indicator of inadequate dietary intake and poor health. Maternal malnutrition significantly impacts maternal and child health outcomes, increasing the mother's risk of dying during delivery. High-risk fertility behaviour is a barrier to reducing mother and child mortality. This study aims to examine the level of high-risk fertility behaviour and anaemia among ever-married urban Indian women and also examine the linkages between the both. METHODS Based on the National Family Health Survey's fifth round of data, the study analyzed 44,225 samples of ever-married urban women. Univariate and bivariate analysis and binary logistic regression have been used for the analysis. RESULTS Findings suggested that more than half (55%) of the urban women were anaemic, and about one-fourth (24%) of women had any high-risk fertility behaviour. Furthermore, the results suggest that 20% of women were more vulnerable to anaemia due to high-risk fertility behaviour. For the specific category, 19% and 28% of women were more likely to be anaemic due to single and multiple high-risk fertility. However, after controlling for sociodemographic factors, the findings showed a statistically significant link between high-risk fertility behaviour and anaemia. As a result, 16% of the women were more likely to be anaemic due to high-risk fertility behaviour, and 16% and 24% were more likely to be anaemic due to single and multiple high-risk fertility behaviour, respectively. CONCLUSIONS The findings exposed that maternal high-risk fertility behaviour is a significant factor in raising the chance of anaemia in ever-married urban women of reproductive age in forms of the short birth interval, advanced maternal age, and advanced maternal age & higher order. Policy and choice-based family planning techniques should be employed to minimize the high-risk fertility behaviour among Indian urban women. This might aid in the reduction of the malnutrition status of their children.
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Affiliation(s)
- Sanjay Kumar Pal
- Department of Fertility & Social Demography, International Institute for Population Sciences, Mumbai-400088, India.
| | - Chander Shekhar
- Department of Fertility & Social Demography, International Institute for Population Sciences, Mumbai-400088, India
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Rahman MA, Islam MA, Tohan MM, Muhibullah SM, Rahman MS, Howlader MH. Socioeconomic inequalities in utilizing maternal health care in five South Asian countries: A decomposition analysis. PLoS One 2024; 19:e0296762. [PMID: 38335177 PMCID: PMC10857732 DOI: 10.1371/journal.pone.0296762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/18/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND High maternal mortality rates still today remain a significant public health concern in South Asian countries. The majority of maternal deaths occur during pregnancy, and these deaths may typically be avoided by ensuring that women have access to reliable maternity care such as antenatal care (ANC) and facility delivery. The objectives of this research were to assess socioeconomic disparities in the utilization of health care services by mothers and to determine the factors influencing this utilization among women aged 15 to 49 in five South Asian countries. METHODS For this study, nationally representative data from the Demographic and Health Survey (DHS) were analyzed. This research included a total of 262,531 women between the ages of 15 and 49. To determine the likely causes of maternal health care utilization, simple bivariate statistics and binary logistic regression were applied, and decomposition analysis and the concentration curve were used to quantify disparity (Lorenz curve). RESULTS ANC and institutional delivery were both prevalent in 59.27% and 86.52% of cases, respectively. Among the five nations, Maldives has the greatest ANC (96.83%) and institutional delivery (99.39%), while Bangladesh has the lowest ANC (47.01%) and institutional delivery (49.81%). Women's and husbands' education, household wealth status, BMI, and urban residents are the most important factors influencing maternal health service utilization, whereas higher education level, affluent wealth quintiles, and place of residence are the major contributors to socioeconomic inequalities in access to maternal health care that favor the wealthy. CONCLUSION Maternal health care services must be utilized properly in order to promote optimal health and prevent maternal mortality. Several socioeconomic and sociodemographic variables of the individual population, as well as policy issues, all have an impact on maternal mortality. This research recommends for concerted action to enhance how successfully women use maternity care services.
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Affiliation(s)
- Md. Ashfikur Rahman
- Development Studies Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - Md. Amirul Islam
- Development Studies Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - Mortuja Mahamud Tohan
- Development Studies Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - S. M. Muhibullah
- Statistics Discipline, Science, Engineering and Technology School, Khulna University, Khulna, Bangladesh
| | - Md. Sazedur Rahman
- Statistics Discipline, Science, Engineering and Technology School, Khulna University, Khulna, Bangladesh
| | - Md. Hasan Howlader
- Development Studies Discipline, Social Science School, Khulna University, Khulna, Bangladesh
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Elia EF, Ayungo J. Socio-demographic influence on the pregnant women's comprehension of maternal health information in Tanzania. Heliyon 2023; 9:e22448. [PMID: 38046146 PMCID: PMC10686842 DOI: 10.1016/j.heliyon.2023.e22448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 12/05/2023] Open
Abstract
Background Pregnant women's understanding of maternal health information is critical in the application of information for pregnancy care, birth preparedness, and newborn care. However, the influence of socio-demographic characteristics on pregnant women's understanding of maternal health information is least understood. Purpose The study examined the influence of social and demographic characteristics on pregnant women's comprehension of maternal health information. Methodology A mixed research approach and descriptive cross-sectional design were applied. Questionnaires and focus group discussions were used to collect data from 132 pregnant women and 8 nurses/midwives. Data were analyzed using IBM SPSS version 21 and thematic analysis. Findings Most of the pregnant women had a good ability to comprehend maternal health information. Level of education was found to influence the reading ability and language understanding ability of the pregnant women unlike age, marital status, income, and occupation. Age, level of education, monthly income, occupation, and marital status were found to influence the ability of pregnant women to understand maternal health information. Conclusion The socio-demographic characteristics of pregnant women have an influence on their ability to comprehend maternal health information.
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Affiliation(s)
- Emmanuel F. Elia
- Information Studies Programme, College of Social Sciences, University of Dar es Salaam, Tanzania
| | - Jelly Ayungo
- Directorate of Library Services, University of Dodoma, Tanzania
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Oyekale AS. Utilization of Proximate Healthcare Facilities and Children's Wait Times in Senegal: An IV-Tobit Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7016. [PMID: 37947572 PMCID: PMC10650125 DOI: 10.3390/ijerph20217016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/24/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
Universal health coverage (UHC) defines individuals' timely access to healthcare services without suffering any health-related financial constraints. The Senegalese government has shown commitments towards achievement of UHC as a way of improving access by the population to quality healthcare services. This is very pertinent for promoting some indicators of under-five health in Senegal. Therefore, this study analyzed the factors influencing sick children's utilization of the nearest healthcare facilities and their wait times in Senegal. The data were from the Service Provision Assessment (SPA) survey, which was conducted in 2018. The instrumental Tobit regression model was used for data analysis. The results showed that 63.50% and 86.01% of the children utilized health posts and publicly owned facilities, respectively. Also, 98.46% of the children utilized urban facilities. The nearest facilities were utilized by 74.55%, and 78.19% spent less than an hour in the facilities. The likelihood of using the nearest healthcare facilities significantly reduced (p < 0.05) with caregivers' primary education, higher education, residence in some regions (Fatick, Kaokack, Saint Louis, Sediou, and Tambacounda), and use of private/NGO not-for-profit facilities, but increased with not having visited any other providers, residence in the Kaffrie region, vomiting symptoms, use of health centers, and use of health posts. Moreover, treatment wait times significantly increased (p < 0.05) with the use of nearest facilities, residence in some regions (Diourbel, Kaokack, Matam and Saint Louis), use of private for-profit facilities, use of private not-for-profit facilities, and urban residence, but decreased with secondary education, use of health centers, use of health posts, vomiting symptoms, and showing other symptoms. It was concluded that reduction in wait times and utilization of the nearest healthcare facilities are fundamental to achieving UHC in Senegal. Therefore, more efforts should be integrated at promoting regional and sectoral equities through facilitated public and private healthcare investment.
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Affiliation(s)
- Abayomi Samuel Oyekale
- Department of Agricultural Economics and Extension, North-West University Mafikeng Campus, Mmabatho 2735, South Africa
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Patwardhan M, Li SJ, Miles T, Dere H, Khushalani D, Desai S. Types of health service utilization in Mumbai slums: a community-based survey. BMC Res Notes 2023; 16:289. [PMID: 37875959 PMCID: PMC10598993 DOI: 10.1186/s13104-023-06557-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 10/05/2023] [Indexed: 10/26/2023] Open
Abstract
OBJECTIVE Sociodemographic factors play a crucial role in shaping the health-seeking behaviors of individuals residing in slum areas, particularly in their choice of healthcare facilities. Recognizing the importance of strengthening the existing healthcare systems, this research project was undertaken with the primary objective of comprehending the health-seeking behaviors among residents of Mumbai's slum dwellings in India. To achieve this goal, a comprehensive cross-sectional community needs assessment was conducted spanning from October 2018 to January 2019. RESULTS 432 respondents reported utilizing at least one health facility in the past year. They reported using private hospitals (172), public hospitals (208), Community Health clinics [23], or other healthcare services (29). To gain further insights into the factors influencing these choices, logistic regression analysis was conducted. The analysis revealed that being female was found to be negatively associated with the selection of a general practitioner as a preferred healthcare provider. On the other hand, higher levels of education and income were found to have a positive association with the preference for private hospitals. Conversely, these factors were negatively associated with the choice of government hospitals.
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Shanto HH, Al-Zubayer MA, Ahammed B, Sarder MA, Keramat SA, Hashmi R, Haque R, Alam K. Maternal Healthcare Services Utilisation and Its Associated Risk Factors: A Pooled Study of 37 Low- and Middle-Income Countries. Int J Public Health 2023; 68:1606288. [PMID: 37936874 PMCID: PMC10625904 DOI: 10.3389/ijph.2023.1606288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/09/2023] [Indexed: 11/09/2023] Open
Abstract
Objectives: The utilisation of maternal healthcare services (MHS) can play an essential role in reducing maternal deaths. Thus, this study examines the prevalence and factors associated with MHS utilisation in 37 low-and-middle-income countries (LMICs). Methods: A total of 264,123 women were obtained from the Demographic and Health Surveys of 37 LMICs. Multivariate logistic regression was performed to identify the factors associated with maternal healthcare services utilisation. Results: Around one-third (33.7%) of the respondents properly utilise MHS among women of childbearing age. In the pooled sample, the odds of MHS utilisation were significantly higher with the increase in wealth index, women's age, age at the first birth, and husband/partner's education. Urban residence (AOR [adjusted odds ratio] = 1.56; 95% CI [confidence interval]: 1.49-1.64), women's autonomy in healthcare decision-making (AOR = 1.19; 95% CI: 1.15-1.24) and media exposure (AOR = 1.70; 95% CI: 1.58-1.83) were found to be the strongest positive factors associated with utilisation of MHS. In contrast, larger family (AOR = 0.93; 95% CI: 0.91-0.96), and families with 7 or more children (AOR = 0.72; 95% CI: 0.68-0.77) were significantly negatively associated with MHS utilisation. Conclusion: The utilisation of MHS highly varied in LMICs and the associated factors. Expanding the wealth status, education, age at first birth, mothers' autonomy in healthcare decisions, and media exposure could be essential strategies for increasing the utilisation of MHS; however, country-specific programs should be considered in national policy discussions. There is a need to formulate policies and design maternal health services programs that target socially marginalised women.
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Affiliation(s)
- Hasibul Hasan Shanto
- Statistics Discipline, Science, Engineering and Technology (SET) School, Khulna University, Khulna, Bangladesh
| | - Md. Akib Al-Zubayer
- Statistics Discipline, Science, Engineering and Technology (SET) School, Khulna University, Khulna, Bangladesh
| | - Benojir Ahammed
- Statistics Discipline, Science, Engineering and Technology (SET) School, Khulna University, Khulna, Bangladesh
| | - Md. Alamgir Sarder
- Statistics Discipline, Science, Engineering and Technology (SET) School, Khulna University, Khulna, Bangladesh
| | - Syed Afroz Keramat
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Rubayyat Hashmi
- Centre for Housing Research, The University of Adelaide, Adelaide, SA, Australia
| | - Rezwanul Haque
- School of Business, University of Southern Queensland, Toowoomba, QLD, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Khorshed Alam
- School of Business, University of Southern Queensland, Toowoomba, QLD, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
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Singh T, Kaur R, Kant S, Mani K, Yadav K, Gupta SK. Maternal Healthcare Services in a Rural Area of Haryana during the COVID-19 Pandemic: A Community-Based Study. Indian J Community Med 2023; 48:715-720. [PMID: 37970159 PMCID: PMC10637588 DOI: 10.4103/ijcm.ijcm_43_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/30/2023] [Indexed: 11/17/2023] Open
Abstract
Background It is well documented that the utilization of maternal healthcare services during pregnancy and childbirth plays a significant role in reducing maternal morbidity and mortality. Disruptions in maternal healthcare services during the coronavirus disease 2019 (COVID-19) pandemic have been reported. However, there is a paucity of literature from rural areas, as most of the previous studies are either record-based or conducted in tertiary care centers. This study aimed to determine the proportion of women who received the recommended maternal healthcare services during the COVID-19 pandemic and to study various factors associated with the utilization of services. Material and Methods In this community-based study, we assessed the utilization of maternal healthcare services among 520 women residing in the Ballabgarh Block of District Faridabad, Haryana, whose antenatal, intrapartum, and postnatal period coincided with the first wave of COVID-19 pandemic. Domiciliary visits were made, and women were interviewed retrospectively regarding maternal healthcare services utilized by them. The antenatal care (ANC) cards were reviewed, and details were corroborated. Results Full ANC was received by 15.3% of women, and 45% of women had less than four antenatal visits. 30.9% of participants had cesarean delivery. The proportion of cesarean delivery in private facilities was significantly higher than in government facilities [Odds Ratio (OR) (95% Confidence intervals (CI)) =10.04 (5.87-17.19); P < 0.001]. In multivariate logistic regression, gravidity was negatively associated with full ANC [OR (95% CI) =0.43 (0.25-0.74); P = 0.002]. Conclusion Fewer women received the recommended maternal healthcare services during the COVID-19 pandemic. Detailed assessment of health systems and factors affecting routine healthcare services, during the pandemic, can help improve the readiness and response in the future.
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Affiliation(s)
- Tejbeer Singh
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ravneet Kaur
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shashi Kant
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kalaivani Mani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Yadav
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar Gupta
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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Adedokun ST, Uthman OA, Bisiriyu LA. Determinants of partial and adequate maternal health services utilization in Nigeria: analysis of cross-sectional survey. BMC Pregnancy Childbirth 2023; 23:457. [PMID: 37340350 DOI: 10.1186/s12884-023-05712-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 05/16/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Access to health services during pregnancy, childbirth and the period after birth provides a substantial opportunity to limit cases of maternal mortality. In sub-Saharan Africa, the proportions of women who utilize health services remain below 70%. This study examined the factors associated with partial and adequate maternal health services utilization in Nigeria. METHODS This paper used data from 2018 Nigeria Demographic and Health Survey (DHS) comprising 21,792 women aged 15-49 years who had given births within five years of the survey. The study focused on antenatal care attendance, place of birth and postnatal care using a combined model. Multinomial logistic regression was applied in the analysis. RESULTS About 74% of the women attended antenatal care, 41% gave birth in health facilities and 21% attended postnatal care. While 68% of the women partially utilized health services, 11% adequately utilized the services. The odds of partially and adequately utilizing health services increased for ever married women, women with secondary or higher education, from richest households, living in urban area, having no problem either getting permission to visit health facility or reaching health facility. CONCLUSIONS This study has revealed the factors associated with partial and adequate utilization of maternal health services in Nigeria. Such factors include education, household wealth, marital status, employment status, residence, region, media exposure, getting permission to use health service, unwillingness to visit health facility without being accompanied and distance to health facility. Efforts aimed at improving maternal health services utilization should place emphasis on these factors.
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Affiliation(s)
- Sulaimon T Adedokun
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - Olalekan A Uthman
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School, Coventry, UK
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Luqman A Bisiriyu
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
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Birhanu F, Yitbarek K, Woldie M. Client retention in the continuum of maternal health services in Ethiopia. BMC Health Serv Res 2023; 23:569. [PMID: 37268946 DOI: 10.1186/s12913-023-09602-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/25/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Even though the global maternal mortality has shown an impressive decline over the last three decades, the problem is still pressing in low-income countries. To bring this to an end, women in a continuum of maternity care should be retained. This study aimed to assess the status of Ethiopian women's retention in the continuum of maternity care with their possible predictors. METHODS We used data from the 2019 Ethiopian Mini-Demographic and Health Survey. The outcome variable in this study was retention in the continuum of maternity care, which consists of at least four ANC contacts, delivery in a health facility, and postnatal check within 48 h of delivery. We analyzed the data using STATA version 14 and a binary logistic regression model was used. In the multiple logistic regression model, variables with a p-value ≤ 0.05 were considered as significantly associated with the outcome variable. A weighted analysis was also done. RESULTS Of the 3917 women included in this study, only 20.8% of women completed all of the recommended services. Besides, the use of maternal health services favors women living in the biggest city administrations, followed by women living in agrarian regions; however, those living in the pastoralist area were disadvantaged. Having four or more ANC was explained by the maternal secondary level of education [AOR: 2.54; 95% CI: 1.42, 4.54], wealth status [AOR: 2.59; 95% CI: 1.45, 4.62], early initiation of ANC [AOR: 3.29; 95% CI: 2.55, 4.24], and being in a union [AOR: 1.95; 95% CI: 1.16,3.29]. After having four ANC, factor-affecting delivery in a health facility was wealth status [AOR: 8.64; 95% CI: 4.07, 18.36]. The overall completion of care was associated with women's higher level of education [AOR: 2.12; 95% CI: 1.08, 4.25], richest wealth status [AOR: 5.16; 95% CI: 2.65, 10.07], timeliness of the first ANC visit [AOR: 2.17; 95% CI: 1.66, 2.85], and third birth order [AOR: 0.58; 95% CI: 0.35, 0.97]. CONCLUSIONS Despite the efforts by the Ethiopian government and other stakeholders, the overall completion of care was quite low. There is also a clear inequality because of women's background characteristics and regional variation. Strategies aiming to empower women through improved educational experience and economic standing have to be implemented in collaboration with other relevant sectors.
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Affiliation(s)
- Frehiwot Birhanu
- School of Public Health, College of Health Science, Mizan-Tepi University, P.O.B. 260, Mizan-Aman, Ethiopia.
| | - Kiddus Yitbarek
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Mirkuzie Woldie
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
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Singh A, Kumar V, Singh H, Chowdhury S, Sharma S. Assessing the coverage of full antenatal care among adolescent mothers from scheduled tribe and scheduled caste communities in India. BMC Public Health 2023; 23:798. [PMID: 37127687 PMCID: PMC10150462 DOI: 10.1186/s12889-023-15656-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/11/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND The persistently high rates of maternal mortality and morbidity among historically marginalised social groups, such as adolescent Scheduled Castes (SCs) and Scheduled Tribes (STs) in India, can be attributed, in part, to the low utilisation of full antenatal healthcare services. Despite efforts by the Indian government, full antenatal care (ANC) usage remains low among this population. To address this issue, it is crucial to determine the factors that influence the utilisation of ANC services among adolescent SC/ST mothers. However, to date, no national-level comprehensive study in India has specifically examined this issue for this population. Our study aims to address this research gap and contribute to the understanding of how to improve the utilisation of ANC services among adolescent SC/ST mothers in India. DATA AND METHODS Data from the fourth round of the National Family Health Survey 2015-16 (NFHS-4) was used. The outcome variable was full antenatal care (ANC). A pregnant mother was considered to have 'full ANC' only when she had at least four ANC visits, at least two tetanus toxoid (TT) injections, and consumed 100 or more iron-folic acid (IFA) tablets/syrup during her pregnancy. Bivariate analysis was used to examine the disparity in the coverage of full ANC. In addition, binary logistic regression was used to understand the net effect of predictor variables on the coverage of full ANC. RESULTS The utilisation of full antenatal care (ANC) among adolescent SC/ST mothers was inadequate, with only 18% receiving full ANC. Although 83% of Indian adolescent SC/ST mothers received two or more TT injections, the utilisation of the other two vital components of full ANC was low, with only 46% making four or more ANC visits and 28% consuming the recommended number of IFA tablets or equivalent amount of IFA syrup. There were statistically significant differences in the utilisation of full ANC based on the background characteristics of the participants. The statistical analysis showed that there was a significant association between the receipt of full ANC and factors such as religion (OR = 0.143, CI = 0.044-0.459), household wealth (OR = 5.505, CI = 1.804-16.800), interaction with frontline health workers (OR = 1.821, CI = 1.241-2.670), and region of residence in the Southern region (OR = 3.575, CI = 1.917-6.664). CONCLUSION In conclusion, the study highlights the low utilisation of full antenatal care services among Indian adolescent SC/ST mothers, with only a minority receiving the recommended number of ANC visits and consuming the required amount of IFA tablets/syrup. Addressing social determinants of health and recognising the role of frontline workers can be crucial in improving full ANC coverage among this vulnerable population. Furthermore, targeted interventions tailored to the unique needs of different subgroups of adolescent SC/ST mothers are necessary to achieve optimal maternal and child health outcomes.
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Affiliation(s)
- Aditya Singh
- Department of Geography, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
- External Research Collaborator, Girl Innovation, Research and Learning (GIRL) Centre, Population Council, New York, USA
| | - Vineet Kumar
- Department of Geography, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
| | - Harpreet Singh
- Department of Geography, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sourav Chowdhury
- Department of Geography, Raiganj University, Raiganj, West Bengal, India
| | - Sanjana Sharma
- Department of Geography, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Al-Zubayer MA, Shanto HH, Kumkum R, Alam ST, Ahammed B. Prevalence and socioeconomic determinants of awareness and visitation of community clinic among ever married women: evidence from Bangladesh Demographic and Health Survey, 2017-2018. BMJ Open 2023; 13:e067823. [PMID: 36759030 PMCID: PMC9923255 DOI: 10.1136/bmjopen-2022-067823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVES Bangladesh has made remarkable progress in improving the population's health, but maternal health and healthcare facilities are still in a vulnerable situation. This study aims to investigate the prevalence and determinants of awareness and visitation of community clinics (CCs) in Bangladesh. DESIGN A population-based cross-sectional study. SETTING The data were collected from the most recent Bangladesh Demographic and Health Survey conducted in 2017-2018. PARTICIPANTS This study's participants are 18 893 women aged 15-49 years throughout all administrative regions. PRIMARY AND SECONDARY OUTCOME MEASURES The outcomes are awareness and visitation of CCs, defined as if women are aware and visit of CCs. MATERIALS AND METHODS Descriptive statistics, bivariate and multivariate binary logistics analysis were used to determine the prevalence and associated factors of awareness and visitation of CCs. RESULTS The prevalence of awareness and visitation to CCs were 60.26% and 15.92%, respectively. The result of the multivariate analysis revealed that higher education, division and higher number of children were significantly positively associated, whereas the richest wealth index was significantly negatively associated with both awareness and visitation to CCs. Furthermore, the urban residence was negatively and respondent involvement in currently working was positively significantly related to awareness of CCs. Moreover, male household heads and exposure to media were significantly positively related to visitation to CCs. CONCLUSION The study result highlights that more than half of the women were aware of CCs however, the CCs' visit rates were comparatively low. Priority-based public health programmes for women through community health workers are urgently needed to increase the awareness and visitation of CCs.
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Affiliation(s)
| | | | - Rabeya Kumkum
- Statistics Discipline, Khulna University, Khulna, Bangladesh
| | | | - Benojir Ahammed
- Statistics Discipline, Khulna University, Khulna, Bangladesh
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Nagdev N, Ogbo FA, Dhami MV, Diallo T, Lim D, Agho KE. Factors associated with inadequate receipt of components and non-use of antenatal care services in India: a regional analysis. BMC Public Health 2023; 23:6. [PMID: 36597104 PMCID: PMC9808929 DOI: 10.1186/s12889-022-14812-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 12/06/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Failure to use antenatal care (ANC) and inadequate receipt of components of ANC pose a significant risk for the pregnant woman and the baby. This study aimed to examine a regional analysis of factors associated with receiving no ANC and inadequate receipt of components of ANC services among Indian women. METHOD Information from 173,970 women of reproductive age 15-49 years from the 2019-21 India National Family Health Survey (NFSH-5) was analysed. Logistic regression analyses that adjusted for cluster and survey weights were conducted to assess the socio-demographic and other factors associated with receiving non-use of ANC and inadequate receipt of components of ANC, respectively, in the six regions and 28 states, and 8 union territories in India. RESULTS Across regions in India, 7% of women reported no ANC, and the prevalence of inadequate and adequate receipt of components of ANC in all six regions ranged from 67 to 89% and 8% to 24%, respectively. Of all the 36 federated entities, the prevalence of inadequate receipt of ANC components was less than two-thirds in Tamil Nadu, Puducherry, Andaman and the Nicobar Islands, Odisha, and Gujarat. Our analyses revealed that associated factors vary by region, state, and union territories. Women from poor households reported increased odds of receiving no ANC in North, East and North-eastern regions. Women who reported no schooling in South, East and Central regions were associated with increased odds of receiving no ANC. Women from poor households in Himachal Pradesh, Bihar, Uttar Pradesh, Nagaland, Manipur, Uttar Pradesh, and Madhya Pradesh states reported significantly higher odds of inadequate components ANC than women from rich households. The receipt of inadequate components of ANC was significantly higher among women who never read magazines in Delhi, Ladakh, Karnataka, Telangana, Jharkhand, Maharashtra, Uttar Pradesh, Chhattisgarh, Arunachal Pradesh, Manipur, and Mizoram states in India. CONCLUSION A better understanding of the factors associated with and incorporating them into the short- and long-term intervention strategies, including free financial support from the Indian government to encourage pregnant women from lower socioeconomic groups to use health services across all regions, states and union territories.
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Affiliation(s)
- Nilu Nagdev
- grid.1029.a0000 0000 9939 5719School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - Felix Akpojene Ogbo
- grid.1029.a0000 0000 9939 5719Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Narellan Road and Gilchrist Drive, Campbelltown, NSW 2560 Australia ,Riverland Academy of Clinical Excellence (RACE), Riverland Mallee Coorong Local Health Network, SA Health
- Government of South Australia, Berri, SA 5343 Australia ,Patrick Street Family Practice, 8-22 Patrick Street, PO Box 491, Stawell, VIC 3380 Australia
| | - Mansi Vijaybhai Dhami
- grid.1029.a0000 0000 9939 5719Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Narellan Road and Gilchrist Drive, Campbelltown, NSW 2560 Australia ,grid.460685.90000 0004 0640 206XBelmont Hospital, 16 Croudace Bay Road, Belmont, NSW 2280 Australia
| | - Thierno Diallo
- grid.1029.a0000 0000 9939 5719Humanitarian & Development Studies, School of Social Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - David Lim
- grid.1029.a0000 0000 9939 5719School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia ,grid.1029.a0000 0000 9939 5719Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Narellan Road and Gilchrist Drive, Campbelltown, NSW 2560 Australia
| | - Kingsley E. Agho
- grid.1029.a0000 0000 9939 5719School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia ,grid.1029.a0000 0000 9939 5719Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Narellan Road and Gilchrist Drive, Campbelltown, NSW 2560 Australia ,grid.16463.360000 0001 0723 4123African Vision Research Institute (AVRI), University of KwaZulu-Natal, Westville Campus, Durban, 3629 South Africa
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Datta B, Pandey A, Tiwari A. Child Marriage and Problems Accessing Healthcare in Adulthood: Evidence from India. Healthcare (Basel) 2022; 10:healthcare10101994. [PMID: 36292439 PMCID: PMC9601764 DOI: 10.3390/healthcare10101994] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 11/04/2022] Open
Abstract
The association between child marriage and the access to or utilization of maternal and antenatal healthcare has been widely studied. However, little is known about child brides' access to healthcare for illnesses later in life. Using data on 496,283 married women aged 18 to 49 years from the India National Family and Health Survey 2015-2016, we developed an 11-point composite score (ranging from 0 to 10) outlining the extent of problems accessing healthcare, as follows: (i) no/little problem (score 0 to 2), (ii) some problems (score 3 to 6), and (iii) big problems (score 7 to 10). The differences between child brides and their peers married as adults were assessed by the relative risk ratios obtained from multinomial logistic regressions. The adjusted risk of having "some problems" and "big problems" accessing healthcare relative to "no/little problem" for child brides was found to be 1.22 (95% CI: 1.20-1.25) and 1.26 (95% CI: 1.22-1.29) times that of those married as adults, respectively. These findings highlight the disproportionate barriers to healthcare access faced by women married as children compared to women married as adults and the need for further research to inform policies regarding effective public health interventions to improve healthcare access.
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Affiliation(s)
- Biplab Datta
- Institute of Public and Preventive Health, Augusta University, Augusta, GA 30912, USA
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Correspondence:
| | - Ajay Pandey
- Department of Biological Sciences, Augusta University, Augusta, GA 30912, USA
| | - Ashwini Tiwari
- Institute of Public and Preventive Health, Augusta University, Augusta, GA 30912, USA
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Aboagye RG, Seidu AA, Ahinkorah BO, Cadri A, Frimpong JB, Hagan JE, Kassaw NA, Yaya S. Association between frequency of mass media exposure and maternal health care service utilization among women in sub-Saharan Africa: Implications for tailored health communication and education. PLoS One 2022; 17:e0275202. [PMID: 36174071 PMCID: PMC9522280 DOI: 10.1371/journal.pone.0275202] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 09/12/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Awareness creation through mass media has the potential to promoted positive behaviors and discourage negative health-related behaviors through direct and indirect pathways. In this study, we examined the association between exposure to mass media and maternal health care services utilization among women in sub-Saharan Africa. METHODS We used data from the recent Demographic and Health Surveys (DHS) conducted between 2010 and 2020. A total of 28 countries with a survey dataset within 2010-2020 were included in our study. We included 199,146 women who had ever had a pregnancy in the last five years preceding the survey. Weighting was applied. Multilevel mixed-effect models were considered to account for cluster-level variations and correct inferences. Fixed and random effects estimates were reported. Adjusted odds ratio (aOR) with their 95% confidence intervals (CIs) were used to present the results. Also, we presented the random intercept variations, intraclass correlation coefficient, and model fitness. RESULTS Women who listened to radio at least once every week (aOR = 1.11, 95% CI = 1.07,1.15) were more likely to attend ANC as against those who did not listen to radio at all. Also, women who watched television at least once a week (aOR = 1.39, 95% CI = 1.33,1.46) were more likely to attend ANC compared to those who did not watch television at all. Women who read newspaper/magazine at least once a week (aOR = 1.27, 95% CI = 1.14,1.41); listened to radio at least once a week (aOR = 1.12, 95% CI = 1.07,1.17); and watched television at least once a week (aOR = 1.32, 95% CI = 1.24,1.40), were more likely to utilize SBA than those who did not read newspaper/magazine; listen to radio; and watch television at all. Women who read newspaper/magazine at least once a week (aOR = 1.35, 95% CI = 1.27,1.45); listened to radio at least once a week (aOR = 1.37, 95% CI = 1.32,1.42); and watched television at least once a week (aOR = 1.39, 95% CI = 1.32,1.47) were more likely to utilize PNC compared to those who did not. CONCLUSIONS The study identified a strong positive relationship between mass media exposure and maternal health care services utilization. Specifically, exposure to radio and television were positively associated with ANC visitations. Moreover, exposure to mass media (newspaper/magazine, radio and television) were positively associated with SBA and PNC utilization. Policymakers and other non-governmental organizations should continuously invest resources in the design and implementation of maternal health service utilization educational programs through all the mass media channels to scale up women's maternal health service services utilization uptake in sub-Saharan Africa.
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Affiliation(s)
- Richard Gyan Aboagye
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Abdul-Aziz Seidu
- Department of Estate Management, Takoradi Technical University, Takoradi, Ghana
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Abdul Cadri
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Social and Behavioural Science, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - James Boadu Frimpong
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - John Elvis Hagan
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
- Faculty of Psychology and Sport Sciences, Neurocognition and Action-Biomechanics-Research Group, Bielefeld University, Bielefeld, Germany
| | | | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, Imperial College London, London, United Kingdom
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Abstract
Short Birth Interval (SBI) is one of the main causes of adverse maternal and child health outcomes. A 33-month birth-to-birth interval between two successive live births should be followed to minimize the risk of adverse maternal and child health. This study aimed to examine the prevalence of SBI and the associated factors in rural India. Information on 98,522 rural mothers from the fourth round of National Family Health Survey data was analyzed. Bivariate statistics, logistic regression, Moran's I, and Cluster and Outlier Analysis have been used to assess the prevalence and spatial pattern of SBI in rural India. Results revealed that about half of the mothers in rural India had experienced SBI. Rural Indian mothers whose child was not alive (OR = 1.76, 95% CI = 1.63-1.90), were not using any contraceptive methods (OR = 1.42, 95 % CI = 1.37-1.48) and not breastfeeding (OR = 2.73, 95% CI = 2.50-2.97) were more likely to experience SBI. On the other hand, rural mothers from the middle, richer and richest wealth quintiles (OR = 0.91, 95% CI = 0.86-0.97; OR = 0.84, 95% CI = 0.80-0.92; OR = 0.60, 95% CI = 0.55-0.66) and of age over 30 years (OR = 0.38., 95% CI = 0.36-0.39) were less likely to experience SBI. Analysis of spatial patterns revealed clear east-west differences in the prevalence of SBI. There was strong clustering of high values of SBI in most districts across the central, northern, western, and southern regions. The study suggests the need to introduce appropriate interventions and programs focused on reducing the prevalence of SBI in rural India.
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Scaria L, Soman B, George B, Ahamed Z, Hariharan S, Jeemon P. Determinants of very low birth weight in India: The National Family Health Survey – 4. Wellcome Open Res 2022; 7:20. [PMID: 35694198 PMCID: PMC9171295 DOI: 10.12688/wellcomeopenres.17463.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background
Low birth weight (LBW) is susceptible to neonatal complications, chronic medical conditions, and neurodevelopmental disabilities. We aim to describe the determinants of very low birth weight (VLBW) in India and compare it with the determinants of LBW based on the National Family Health Survey – 4 (NHFS-4)
Methods
Data from the NFHS-4 on birthweight and other socio-demographic characteristics for the youngest child born in the family during the five years preceding the survey were used. Data of 147,762 infant–mother pairs were included. Multiple logistic regression models were employed to delineate the independent predictors of VLBW (birth weight<1500 g) or LBW (birth weight: 1500-2499 g).
Results
Of the 147,762 children included in the study, VLBW and LBW were observed in 1.2% and 15.8% of children, respectively. The odds of VLBW were higher in female children (aOR: 1.36, 95% CI: 1.15–1.60), among mothers aged 13–19 years (aOR: 1.58, 95% CI: 1.22–2.07), mothers with severe or moderate anaemia (aOR: 1.61, 95% CI: 1.34–1.94), mothers without recommended antenatal care (aOR: 1.47, 95% CI: 1.31–1.90), maternal height less than 150 cm (aOR: 1.54, 95% CI: 1.29–1.85) and among mothers with multiple pregnancy (aOR: 21.34, 95% CI: 14.70–30.96) in comparison to their corresponding counterparts. In addition to the variables associated with VLBW, educational status of mothers (no education; aOR: 1.08, 95% CI: 1.02–1.15 and primary education; aOR: 1.16, 95% CI: 1.08–1.25), caste of the children (scheduled tribe; aOR: 1.13, 95% CI: 1.03–1.24), and wealthiness of the family (poorest wealth quintiles; aOR: 1.11, 95% CI: 1.03–1.19) were associated with LBW.
Conclusions
Interventions targeting improvements in antenatal care access, maternal health, and nutritional status may reduce the number of VLBW infants. Social determinants of LBW require further detailed study to understand the high propensity of low birth-weight phenotypes in the disadvantaged communities in India.
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Affiliation(s)
- Liss Scaria
- AMCHSS, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Biju Soman
- AMCHSS, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Babu George
- Child Development Centre, Government Medical College, Trivandrum, Kerala, 695011, India
| | - Zulfikar Ahamed
- Child Development Centre, Government Medical College, Trivandrum, Kerala, 695011, India
| | - Sankar Hariharan
- Pediatrics, Government Medical College, SAT Hospital, Trivandrum, Kerala, 695011, India
| | - Panniyammakal Jeemon
- AMCHSS, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
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How do traditional media access and mobile phone use affect maternal healthcare service use in Bangladesh? Moderated mediation effects of socioeconomic factors. PLoS One 2022; 17:e0266631. [PMID: 35476825 PMCID: PMC9045672 DOI: 10.1371/journal.pone.0266631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/23/2022] [Indexed: 11/19/2022] Open
Abstract
Background Exposure to traditional media (TV, radio, and newspapers) and the use of mobile as an interpersonal communication tool allow for a variety of information provision. The purpose of this study is to investigate how women’s media and mobile access affect maternal health service (MHS) utilization. The study also aims to look into the moderated mediation effects of socioeconomic variables on the association mentioned above. Methods The study analyzed reproductive and media data of 5,011 ever-married women extracted from the latest nationally representative Bangladesh Demographic and Health Survey. Hierarchical logistic regression and moderated mediation analysis are performed to determine the association. Results Only 26.9% of women used mobile for health service use, while more than 55% had media access. Media access is significantly associated with all three types of MHS use; mobile usage also has a significant association with antenatal and delivery care. When women have both access to media and mobile, the likelihood of delivering in a health facility increased by 1.82 times (AOR: 1.82, 95%CI: 1.51, 2.20) which is slightly better than having access to only one type of media channel. Women’s education, household wealth, place of residence, religion, and current working status are among the socioeconomic factors associated with access to media and mobile. Women’s education mediates the relationship of media and MHS; however, the mediation effect of women (β: .45; LLCI: .21, ULCI: .68) on the association of media and place of delivery is seen to be moderated by household wealth. Women who belong to well-off families moderates positively (Effect: .33, 95%CI: .27, .40) the education effect of media and where to deliver. Place of residence, another moderator, significantly moderates (Effect: .09, BootLLCI: .02, BootULCI: .16) the mediation effect of women’s education on the association of media and antenatal care visits; women living in urban areas seems to have positively moderated the education effects on the mentioned association. Conclusions Provision of media access and mobile use indicate better utilization of MHS in Bangladesh, and women’s education mediates these relationships via the influence of household wealth and area of residence. Therefore, while planning interventions to increase MHS use, its relationships with the media and mobile use should be extrapolated. The collective use of these channels could be a catalyst for the success of health promotion initiatives to improve women’s health behaviors, build community capacity, and create mass awareness that supports the optimal use of MHS in Bangladesh.
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Aji RS, Efendi F, Kurnia ID, Tonapa SI, Chan CM. Determinants of maternal healthcare service utilisation among Indonesian mothers: A population-based study. F1000Res 2022; 10:1124. [PMID: 35602669 PMCID: PMC9086521 DOI: 10.12688/f1000research.73847.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/20/2022] Open
Abstract
Background: In Indonesia, maternal health care services are widely available, aiming to improve health and survival among mothers. However, these services remain underutilised, and its determining factor was unknown. This study sought to identify determinant factors of maternal healthcare services utilisation among Indonesian mothers. Methods: This population-based cross-sectional study leveraged the 2017 Indonesia Demographic and Health Survey data. A total of 12,033 mothers aged from 15 to 49 years who had a live birth in the five years preceding the survey were included in the analysis. Multivariable logistic regressions were used to identify the determinant factors. Results: Approximately 93.44% of the mothers had adequate antenatal care, 83.73% had a delivery at the healthcare facility, and 71.46% received postnatal care. The mother’s age and household wealth index were the typical determinants of all maternal healthcare services. Determinants of antenatal care visits were husband’s occupational status, the number of children, and access to the healthcare facility. Next, factors that drive mothers’ delivery at the healthcare facility were the mother’s education level, husband’s educational level, and residential area. The use of postnatal care was determined by the mother’s occupational status, husband’s educational level, number of children, wealth index, access to the healthcare facility, and residential area. Conclusions: The utilisation of each maternal healthcare service was determined by various socio-structural and intermediary determinants, but the mother’s age and household wealth index were emerged as the typical determinants of all maternal healthcare services. Providing maternal healthcare services that are adjusted and tuned with these socio determinant factors may ensure that mothers can adequately utilise each service.
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Affiliation(s)
| | - Ferry Efendi
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
- Research Group of Community Health, Surabaya, Indonesia
| | | | - Santo Imanuel Tonapa
- Research Group of Community Health, Surabaya, Indonesia
- School of Nursing, Faculty of Medicine Universitas Sam Ratulangi, Manado, Indonesia
| | - Chong-Mei Chan
- Department of Nursing Science, Faculty of Medicine University of Malaya, Kuala Lumpur, Malaysia
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Zaveri A, Paul P, Roy R, Chouhan P. Facilitators and Barriers to the Utilisation of Maternal Healthcare Services in Empowered Action Group States, India. JOURNAL OF HEALTH MANAGEMENT 2022. [DOI: 10.1177/09720634221088359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The use of adequate reproductive healthcare services is critical to mothers and newborn babies. This study aimed to examine the facilitators and barriers to maternal healthcare utilisation in the Empowered Action Group (EAG) states. Data were drawn from the fourth round of the National Family Health Survey, 2015–16 ( n = 103,984). In this study, full antenatal care (ANC), delivery assistance by the skilled birth attendant (SBA) and postnatal care (PNC) within 2 days of delivery were taken as indicators of maternity care. Overall, approximately 13% of women received full ANC, 69.4% were delivered by SBA and 57.7% had PNC within 2 days of delivery. The findings of this study reveal that urban residence, higher education, wealthier economic status, exposure to mass media and contraceptive use are the facilitators of maternal healthcare utilisation. On the contrary, low levels of education, poverty, marriage during childhood, having a large number of children, belonging to socioeconomically backward castes, having difficulties related to healthcare-seeking and unwanted pregnancies are some of the major barriers to the use of maternity care. This study suggests that policymakers and public health practitioners should design proper healthcare policies and programs to provide quality reproductive healthcare services, particularly among socio-economically vulnerable women.
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Affiliation(s)
- Ankita Zaveri
- Department of Geography, University of Gour Banga, Malda, West Bengal, India
| | - Pintu Paul
- Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi, Delhi, India
| | - Ranjan Roy
- Department of Geography and Applied Geography, University of North Bengal, Raja Rammohunpur, West Bengal, India
| | - Pradip Chouhan
- Department of Geography, University of Gour Banga, Malda, West Bengal, India
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Scaria L, Soman B, George B, Ahamed Z, Hariharan S, Jeemon P. Determinants of very low birth weight in India: The National Family Health Survey – 4. Wellcome Open Res 2022; 7:20. [DOI: 10.12688/wellcomeopenres.17463.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 11/20/2022] Open
Abstract
Background Low birth weight (LBW) is susceptible to neonatal complications, chronic medical conditions, and neurodevelopmental disabilities. We aim to describe the determinants of very low birth weight (VLBW) in India based on the National Family Health Survey – 4 (NHFS-4). Methods Data from the NFHS 4 on birthweight and other socio-demographic characteristics for the youngest child born in the family during the five years preceding the survey were used. Data of 147,762 infant–mother pairs were included. Multiple logistic regression models were employed to delineate the independent predictors of VLBW (birth weight<1500 g) or LBW (birth weight <2500 g). Results Of the 147,762 children included in the study, VLBW and LBW were observed in 1.2% and 15.8% of children, respectively. The odds of VLBW were higher in female children (aOR: 1.36, 95% CI: 1.15–1.60), among mothers aged 13–19 years (aOR: 1.58, 95% CI: 1.22–2.07), mothers with severe or moderate anaemia (aOR: 1.61, 95% CI: 1.34–1.94), mothers without recommended antenatal care (aOR: 1.47, 95% CI: 1.31–1.90), maternal height less than 150 cm (aOR: 1.54, 95% CI: 1.29–1.85) and among mothers with multiple pregnancy (aOR: 21.34, 95% CI: 14.70–30.96) in comparison to their corresponding counterparts. In addition to the variables associated with VLBW, educational status of mothers (no education; aOR: 1.08, 95% CI: 1.02–1.15 and primary education; aOR: 1.16, 95% CI: 1.08–1.25), caste of the children (scheduled tribe; aOR: 1.13, 95% CI: 1.03–1.24), and wealthiness of the family (poorest wealth quintiles; aOR: 1.11, 95% CI: 1.03–1.19) were associated with LBW. Conclusions Interventions targeting improvements in antenatal care access, maternal health, and nutritional status may reduce the number of VLBW infants. Social determinants of LBW require further detailed study to understand the high propensity of low birth-weight phenotypes in the disadvantaged communities in India.
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Health Workers’ Perceptions about Maternal and Adolescent Health among Marginalized Populations in India: A Multi-Centric Qualitative Study. WOMEN 2021. [DOI: 10.3390/women1040021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Frontline workers are instrumental in bridging the gap in the utilization of maternal health services. We performed a qualitative cross-sectional study with medical officers, accredited social health activists (ASHA), and auxiliary nurse midwifes (ANM), across 13 districts of India, in order to understand the barriers and enablers, at the system and population levels, for improving access of adolescents and mothers to services. The data were collected by means of in-depth interviews (IDI) with medical officers and focus group discussions (FGD) with ASHA and ANM in 2016. The interview guide was based on the conceptual framework of WHO health interventions to decrease maternal morbidity. Content analysis was performed. In total, 532 frontline workers participated in 52 FGD and 52 medical officers in IDI. Adolescent clinics seemed nonexistent in most places; however, services were provided, such as counselling, iron tablets, or sanitary pads. Frontline workers perceived limited awareness and access to facilities among women for antenatal care. There were challenges in receiving the cash under maternity benefit schemes. Mothers-in-law and husbands were major influencers in women’s access to health services. Adolescent clinics and antenatal or postnatal care visits should be seen as windows of opportunities for approaching adolescents and women with good quality services.
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Selvaraj S, Karan AK, Mao W, Hasan H, Bharali I, Kumar P, Ogbuoji O, Chaudhuri C. Did the poor gain from India's health policy interventions? Evidence from benefit-incidence analysis, 2004-2018. Int J Equity Health 2021; 20:159. [PMID: 34246269 PMCID: PMC8272306 DOI: 10.1186/s12939-021-01489-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 06/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background Health policy interventions were expected to improve access to health care delivery, provide financial risk protection, besides reducing inequities that underlie geographic and socio-economic variation in population access to health care. This article examines whether health policy interventions and accelerated health investments in India during 2004–2018 could close the gap in inequity in health care utilization and access to public subsidy by different population groups. Did the poor and socio-economically vulnerable population gain from such government initiatives, compared to the rich and affluent sections of society? And whether the intended objective of improving equity between different regions of the country been achieved during the policy initiatives? This article attempts to assess and provide robust evidence in the Indian context. Methods Employing Benefit-Incidence Analysis (BIA) framework, this paper advances earlier evidence by highlighting estimates of health care utilization, concentration and government subsidy by broader provider categories (public versus private) and across service levels (outpatient, inpatient, maternal, pre-and post-natal services). We used 2 waves of household surveys conducted by the National Sample Survey Organisation (NSSO) on health and morbidity. The period of analysis was chosen to represent policy interventions spanning 2004 (pre-policy) and 2018 (post-policy era). We present this evidence across three categories of Indian states, namely, high-focus states, high-focus north eastern states and non-focus states. Such categorization facilitates quantification of reform impact of policy level interventions across the three groups. Results Utilisation of healthcare services, except outpatient care visits, accelerated significantly in 2018 from 2004. The difference in utilisation rates between poor and rich (between poorest 20% and richest 20%) had significantly declined during the same period. As far as concentration of healthcare is concerned, the Concentrate Index (CI) underlying inpatient care in public sector fell from 0.07 in 2004 to 0.05 in 2018, implying less pro-rich distribution. The CI in relation to pre-natal, institutional delivery and postnatal services in government facilities were pro-poor both in 2004 and 2018 in all 3 groups of states. The distribution of public subsidy underscoring curative services (inpatient and outpatient) remained pro-rich in 2004 but turned less pro-rich in 2018, measured by CIs which declined sharply across all groups of states for both outpatient (from 0.21 in 2004 to 0.16 in 2018) and inpatient (from 0.24 in 2004 to 0.14 in 2018) respectively. The CI for subsidy on prenatal services declined from approximately 0.01 in 2004 to 0.12 in 2018. In respect to post-natal care, similar results were observed, implying the subsidy on prenatal and post-natal services was overwhelmingly received by poor. The CI underscoring subsidy for institutional delivery although remained positive both in 2018 and 2004, but slightly increased from 0.17 in 2004 to 0.28 in 2018. Conclusions Improvement in infrastructure and service provisioning through NHM route in the public facilities appears to have relatively benefited the poor. Yet they received a relatively smaller health subsidy than the rich when utilising inpatient and outpatient health services. Inequality continues to persist across all healthcare services in private health sector. Although the NHM remained committed to broader expansion of health care services, a singular focus on maternal and child health conditions especially in backward regions of the country has yielded desired results. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01489-0.
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Affiliation(s)
| | - Anup K Karan
- Indian Institute of Public Health, Gurugram, India
| | - Wenhui Mao
- Centre for Policy Impact in Global Health, Duke University, Durham, NC, 27708, USA
| | - Habib Hasan
- Indian Institute of Public Health, Gurugram, India
| | - Ipchita Bharali
- Centre for Policy Impact in Global Health, Duke University, Durham, NC, 27708, USA
| | - Preeti Kumar
- Public Health Foundation of India, Gurugram, India
| | - Osondu Ogbuoji
- Centre for Policy Impact in Global Health, Duke University, Durham, NC, 27708, USA
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Mishra PS, Pautunthang N, Marbaniang SP, N AK. Geographical divide led inequality in accessing maternal healthcare services between hills and valley regions of Manipur state, India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100744] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Sarkar M, Das T, Roy TB. Determinants or barriers associated with specific routine check-up in antenatal care in gestational period: A study from EAG states, India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Kharbanda R, Naveen R, Misra DP, Gupta L, Agarwal V. Poor maternal and foetal outcomes in women with systemic sclerosis: an interview-based study at a tertiary centre. Rheumatol Int 2021; 41:1133-1142. [PMID: 33682026 DOI: 10.1007/s00296-021-04793-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/16/2021] [Indexed: 12/15/2022]
Abstract
Poor obstetric outcomes are described in rheumatic diseases (RDs) such as systemic sclerosis (SSc). We assessed the effect of the disease in Indian women and compared with those in developed countries and other RDs. Women with SSc (ACR/EULAR 2013 criteria) registered at a tertiary care centre (2010-2016) were interviewed by teleconsultation. Pregnancies occurring after disease onset were compared with those occurring prior to it. Maternal complications included antepartum hemorrhage, postpartum hemorrhage, spontaneous abortion, preterm rupture of membrane, oligohydramnios, infection, prolonged labour, and foetal complications including low birth weight (LBW), intrauterine death (IUD), preterm delivery, and neonatal infection. Results were expressed as median (Interquartile range). Of 200 SSc, 75 patients aged 31 (22-38) years and disease duration 41 (32-50) months were interviewed. Diffuse cutaneous SSc was the most common (42.56%). 127 conceptions before the onset of SSc were compared with 15 after. Among post-diagnosis, 9 (60%) were live births, 3 (20%) spontaneous abortions 1 (6.7%) induced abortion, 2 (13.3%) IUD. Of the live births, 4 (26.7%) were preterm and 3 (20%) were LBW. Pregnancies after disease onset had a higher rate of maternal (OR - 4.9) and foetal (OR - 9.9) complications compared to pregnancies before SSc. Compared to the Italian cohort, Indian SSc patients had a higher abortion rate (OR - 5.8), frequent lower section ceaserean section (OR - 9.4) and lower live births (OR - 0.05). More frequent caesarean deliveries (OR - 93), preterm deliveries (OR - 20) when compared with lupus and favourable maternal outcomes (OR - 0.15), higher preterm deliveries (OR - 9.6) in comparison with Takayasu arteritis were noted. SSc incurs a higher risk of poor maternal as well as the foetal outcome.
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Affiliation(s)
- Rajat Kharbanda
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India
| | - R Naveen
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India
| | - Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India
| | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India.
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India
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Singh P, Singh KK, Singh P. Maternal health care service utilization among young married women in India, 1992-2016: trends and determinants. BMC Pregnancy Childbirth 2021; 21:122. [PMID: 33568078 PMCID: PMC7877063 DOI: 10.1186/s12884-021-03607-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 01/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal deaths among young women (15-24 years) shares 38% of total maternal mortality in India. Utilizing maternal health care services can reduce a substantial proportion of maternal mortality. However, there is a paucity of studies focusing on young women in this context. This paper, therefore, aimed to examine the trends and determinants of full antenatal care (ANC) and skilled birth attendance (SBA) utilization among young married women in India. METHODS The study analysed data from the four rounds of National Family Health Surveys conducted in India during the years 1992-93, 1998-99, 2005-06 and 2015-16. Young married women aged 15-24 years with at least one live birth in the 3 years preceding the survey were considered for analysis in each survey round. We used descriptive statistics to assess the prevalence and trends in full ANC and SBA use. Pooled multivariate logistic regression was conducted to identify the demographic and socioeconomic determinants of the selected maternity care services. The significance level for all analyses was set at p ≤ 0.05. RESULTS The use of full ANC among young mothers increased from 27 to 46% in India, and from 9 to 28% in EAG (Empowered Action Group) states during 1992-2016. SBA utilization was 88 and 83% during 2015-16 by showing an increment of 20 and 50% since 1992 in India and EAG states, respectively. Findings from multivariate analysis revealed a significant difference in the use of selected maternal health care services by maternal age, residence, education, birth order and wealth quintile. Additionally, Muslim women, women belonging to scheduled caste (SC)/ scheduled tribe (ST) social group, and women unexposed to mass media were less likely to utilize both the maternal health care services. Concerning the time effect, the odds of the utilization of full ANC and SBA among young women was found to increase over time. CONCLUSIONS In India coverage of full ANC among young mothers remained unacceptably low, with a wide and persistent gap in utilization between EAG and non-EAG states since 1992. Targeted health policies should be designed to address low coverage of ANC and SBA among underprivileged young mothers and increased efforts should be made to ensure effective implementation of ongoing programs, especially in EAG states.
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Affiliation(s)
- Pooja Singh
- Department of Statistics, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh 221005 India
| | - Kaushalendra Kumar Singh
- Department of Statistics, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh 221005 India
| | - Pragya Singh
- Department of Statistics, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh 221005 India
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Saha R, Paul P. Institutional deliveries in India's nine low performing states: levels, determinants and accessibility. Glob Health Action 2021; 14:2001145. [PMID: 34914883 PMCID: PMC8682830 DOI: 10.1080/16549716.2021.2001145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Despite the implementation of several national-level interventions, institutional delivery coverage remains unsatisfactory in India’s low performing states (LPS), leading to a high burden of maternal mortality. Objective This study investigates the levels, differentials, and determinants of institutional deliveries in LPS of India. The study also delineates a holistic understanding of barriers to delivery at health facilities and the utilization of the Janani Suraksha Yojana (JSY) specifically designed to improve maternal and child health of disadvantaged communities. Methods A cross-sectional study was conducted using data from the National Family Health Survey (NFHS)-4, 2015–16. The study was carried out over India’s nine LPS utilizing 112,518 women who had a living child in the past five years preceding the survey. Bivariate and multivariate regression analysis techniques were used to yield findings. Results Of the study sample, nearly three-quarters (74%) of women delivered in a health institution in the study area, with the majority delivered in public health facilities. The multivariate analysis indicates that women who lived in rural areas, belonged to disadvantaged social groups (e.g. Scheduled caste/tribes and Muslims), and those who married early (before 18 years) were less likely to utilize institutional delivery services. On the other hand, women’s education, household wealth, and exposure to mass media were found to be strong facilitators of delivering in a health facility. Meeting with a community health worker (CHW) during pregnancy emerged as an important predictor of institutional delivery in our study. Further, interaction analysis shows that women who reported the distance was a ‘big problem’ in accessing medical care had significantly lower odds of delivering at a health facility. Conclusions The study suggests emphasizing the quality of in-facility maternal care and awareness about the importance of reproductive health. Furthermore, strengthening sub-national policies specifically in underperforming states is imperative to improve institutional delivery coverage.
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Affiliation(s)
- Ria Saha
- Public Health Consultant, London, UK
| | - Pintu Paul
- Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi, India
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Adedokun ST, Yaya S. Correlates of antenatal care utilization among women of reproductive age in sub-Saharan Africa: evidence from multinomial analysis of demographic and health surveys (2010-2018) from 31 countries. ACTA ACUST UNITED AC 2020; 78:134. [PMID: 33317637 PMCID: PMC7737303 DOI: 10.1186/s13690-020-00516-w] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/07/2020] [Indexed: 12/04/2022]
Abstract
Background Despite a global reduction of about 38% in maternal mortality rate between 2000 and 2017, sub-Saharan Africa is still experiencing high mortality among women. Access to high quality care before, during and after childbirth has been described as one of the effective means of reducing such mortality. In the sub-region, only 52% of women receive at least four antenatal visits. This study examined the factors influencing antenatal care utilization in sub-Saharan Africa. Methods Data from Demographic and Health Surveys (DHS) of 31 countries involving 235,207 women age 15–49 years who had given birth to children within 5 years of the surveys were used in the study. Multinomial logistic regression model was applied in the analysis. Results About 13% of women in sub-Saharan Africa did not utilize antenatal care while 35 and 53% respectively partially and adequately utilized the service. Adequate utilization of antenatal care was highest among women age 25–34 years (53.9%), with secondary or higher education (71.3%) and from the richest households (54.4%). The odds of adequate antenatal care utilization increased for women who are educated up to secondary or higher education level, from richest households, working, living in urban areas, exposed to media and did not experience problem getting to health facility or obtaining permission to visit health facility. Conclusions This study has revealed information not only on women who did not utilize antenatal care but also on women who partially and adequately utilized the service. The study concluded that the correlates of antenatal care utilization in sub-Saharan Africa include socioeconomic and demographic factors, getting permission to visit health facility, unwillingness to visit health facility alone and problem encountered in reaching the health facility.
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Affiliation(s)
- Sulaimon T Adedokun
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON, K1N 6N5, Canada. .,The George Institute for Global Health, Imperial College London, London, UK.
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El-Khatib Z, Kolawole Odusina E, Ghose B, Yaya S. Patterns and Predictors of Insufficient Antenatal Care Utilization in Nigeria over a Decade: A Pooled Data Analysis Using Demographic and Health Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8261. [PMID: 33182288 PMCID: PMC7664852 DOI: 10.3390/ijerph17218261] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/31/2020] [Accepted: 11/05/2020] [Indexed: 11/30/2022]
Abstract
This study investigated the patterns of antenatal care (ANC) utilization and insufficient use of ANC as well as its association with some proximate socio-demographic factors. This was a cross-sectional study using pooled data Nigeria Demographic and Health Surveys from years 2008, 2013 and 2018. Participants were 52,654 women of reproductive age who reported at least one birth in the five years preceding the surveys. The outcome variables were late attendance, first contact after first trimester and less than four antenatal visits using multivariable logistic regression analysis. The overall prevalence of late timing was 74.8% and that of insufficient ANC visits was 46.7%. In the multivariable regression analysis; type of residency, geo-political region, educational level, household size, use of contraceptives, distance to health service, exposure to the media and total number of children were found to be significantly associated with both late and insufficient ANC attendance. About half of the pregnant women failed to meet the recommendation of four ANC visits. Investing on programs to improve women's socio-economic status, addressing the inequities between urban and rural areas of Nigeria in regard to service utilization, and controlling higher fertility rates may facilitate the promotion of ANC service utilization in Nigeria.
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Affiliation(s)
- Ziad El-Khatib
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden;
- World Health Programme, Université du Québec en Abitibi-Témiscamingue (UQAT), Québec, QC J9X 5E4, Canada
| | - Emmanuel Kolawole Odusina
- Department of Demography and Social Statistics, Faculty of Social Sciences, Federal University Oye Ekiti, Oye-Ekiti, Ekiti State, Nigeria;
| | - Bishwajit Ghose
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
- The George Institute for Global Health, Imperial College London, London SW7 2AZ, UK
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Does choice of health care facility matter? Assessing out-of-pocket expenditure and catastrophic spending on emergency obstetric care in India. J Biosoc Sci 2020; 53:481-496. [PMID: 32583761 DOI: 10.1017/s0021932020000310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The key recommendation of the Child Survival and Safe Motherhood programme was the provision of Emergency Obstetric Care (EmOC) for the prevention of maternal mortality, especially in developing countries like India. The objectives of this paper were three-fold: to examine the socioeconomic differentials in mean out-of-pocket expenditure on EmOC in public and private health care facilities in India; to evaluate the catastrophic health expenditure of households at the threshold levels of 5% and 10%; and finally, to assess the effects of various socioeconomic and demographic covariates on the levels of catastrophic health expenditure on EmOC. Data were extracted from the 71st round of the National Sample Survey Office (NSSO) survey conducted in India between January and June 2014. A stratified multi-stage sampling design was followed to conduct the survey. The information was collected from 65,932 households (rural: 36,480; urban: 29,452) and 33,104 individuals across various states and union territories in India. However, the present study had taken only 1653 sample women who availed EmOC care during the last one year preceding the survey date. Binary logistic regression was applied. Large differences in out-of-pocket expenditure on EmOC were found between private and public health care facilities. Mean annual out-of-pocket expenditure by women in private hospitals was INR 23,309 (US$367), which was about 6 times higher than in public hospitals, where mean spending was INR 3651 (US$58). Furthermore, logistic regression analysis showed a significant association between household socioeconomic status and level of catastrophic health expenditure on EmOC. The odds of catastrophic health expenditure in public health facilities among women from the North region were higher than among those from the Central, South and West regions. Age and level of education significantly influenced the mean level of catastrophic health expenditure. Access to good-quality obstetric care is key to reducing the maternal mortality rate and child deaths, and thus achieving Sustainable Development Goal 3. There is an urgent need for policy interventions to reduce the financial burden of households in accessing obstetric care in India.
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