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Lefebvre CH, Starnes JR, Jakubowski A, Omondi A, Manyala J, Wamae J, Rogers A, Mudhune S, Okoth V, Were V, Mbeya J, Yap SV, Omondi P, Ochieng W, Odhong T, Siele C, Wamai R. Factors associated with facility childbirth and skilled birth attendance in Migori County, Kenya and the effect of Lwala Community Alliance intervention: a cross-sectional assessment from the 2019 and 2021 Lwala household surveys. Front Glob Womens Health 2024; 5:1426264. [PMID: 39364185 PMCID: PMC11448359 DOI: 10.3389/fgwh.2024.1426264] [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: 05/29/2024] [Accepted: 09/04/2024] [Indexed: 10/05/2024] Open
Abstract
Background Despite evidence of the beneficial effects of skilled birth attendance (SBA) on maternal health and childbirth outcomes, there are disparities in access across counties in Kenya. These include Migori County which has historically recorded high maternal mortality rates. In 2007, the Lwala Community Alliance was founded to improve health outcomes in this county. The objective of this study is to provide a baseline status of facility childbirth and SBA in Migori and to characterize the effect of Lwala intervention on these outcomes. Methods A cross-sectional household survey was designed for a 10-year study to evaluate the effectiveness of Lwala initiatives. The 2019 and 2021 household surveys were conducted in Lwala intervention wards and in comparison wards with sample sizes of 3,846 and 5,928 mothers, respectively. The survey captured demographic, health, and socioeconomic data at each household, data on SBA and facility childbirth, and explanatory variables. A generalized linear model was used to determine factors associated with SBA. A secondary trend analysis was conducted to determine change over time in the explanatory variables and SBA. To determine the change in SBA rate due to Lwala intervention, controlling for background temporal trends, a difference-in-differences (DiD) model compared SBA rates in intervention wards and comparison wards. Results SBA increased in all surveyed wards and across all explanatory variables from 2019 to 2021. The DiD analysis showed that the SBA rate increased more in Lwala intervention wards than in comparison wards (Adjusted Prevalence Rate Ratio 1.05, p < 0.001, 95%CI 1.03-1.08). The 2021 survey found the highest rates of both facility childbirths (97.9%, 95%CI 96.5-98.7) and SBA (98.2%, 95%CI 97.0-99.0) in North Kamagambo, the oldest ward of Lwala intervention. Higher educational status, four or more ANC visits, marriage/cohabitation, and wealth were significantly associated with increased SBA. Conclusions We provide the first quasi-experimental evidence that Lwala interventions are significantly improving SBA which may inform related initiatives in similar settings. The household-survey data provides a baseline for continued evaluation of Lwala programs, and the breakdown by ward allows for development of specific programmatic targets.
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Affiliation(s)
| | - Joseph R Starnes
- Department of Pediatrics, Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, TN, United States
- Lwala Community Alliance, Rongo, Kenya
| | - Aleksandra Jakubowski
- Department of Health Sciences, Northeastern University, Boston, MA, United States
- Department of Economics, Northeastern University, Boston, MA, United States
| | - Alyn Omondi
- Department of Research, Adaptive Model for Research and Empowerment of Communities, Kisumu, Kenya
| | - Janet Manyala
- Department of Research, Adaptive Model for Research and Empowerment of Communities, Kisumu, Kenya
| | | | | | | | | | - Vincent Were
- Department of Research, Adaptive Model for Research and Empowerment of Communities, Kisumu, Kenya
| | | | - Samantha V Yap
- Department of Cultures, Societies, and Global Studies, Northeastern University, Boston, MA, United States
| | | | - Willys Ochieng
- Department of Health, County Government of Migori, Migori, Kenya
| | - Tom Odhong
- Department of Health, County Government of Migori, Migori, Kenya
| | | | - Richard Wamai
- Lwala Community Alliance, Rongo, Kenya
- Department of Cultures, Societies, and Global Studies, Northeastern University, Boston, MA, United States
- Nigerian Institute of Medical Research, Lagos, Nigeria
- African Centre for Community Investment in Health, Chemolingot, Kenya
- Integrated Initiative for Global Health, Northeastern University, Boston, MA, United States
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Dadjo J, Omonaiye O, Yaya S. Health insurance coverage and access to child and maternal health services in West Africa: a systematic scoping review. Int Health 2023; 15:644-654. [PMID: 37609993 PMCID: PMC10629958 DOI: 10.1093/inthealth/ihad071] [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: 09/01/2022] [Revised: 07/29/2023] [Accepted: 08/02/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND According to the United Nations, the third Sustainable Development Goal, 'Ensure Healthy Lives and Promote Well-Being at All Ages', set numerous targets on child and maternal health. Universal health insurance is broadly seen as a solution to fulfil these targets. West Africa is known to have the most severe maternal mortality and under-five mortality rates in the world. This review seeks to understand whether health insurance provides increased access to services for mothers and children in this region. METHODS The protocol for this review is registered in the International Prospective Register of Systematic Reviews database (CRD42020203859). A search was conducted in the MEDLINE Complete, Embase, CINAHL Complete and Global Health databases. Eligible studies were from West African countries. The population of interest was mothers and children and the outcome of interest was the impact of health insurance on access to services. Data were extracted using a standardized form. The primary outcome was the impact of health insurance on the rate of utilization and access to services. The Joanna Briggs Institute Critical Appraisal Tool was used for methodological assessment. RESULTS Following screening, we retained 49 studies representing 51 study settings. In most study settings, health insurance increased access to child and maternal health services. Other determinants of access were socio-economic factors such as wealth and education. CONCLUSIONS Our findings suggest that health insurance may be a viable long-term strategy to alleviate West Africa's burden of high maternal and child mortality rates. An equity lens must guide future policy developments and significant research is needed to determine how to provide access reliably and sustainably to services for mothers and children in the near and long term.
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Affiliation(s)
- Joshua Dadjo
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Olumuyiwa Omonaiye
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Melbourne Burwood, Victoria, Australia
- Deakin University Centre for Quality and Patient Safety Research – Eastern Health Partnership, Box Hill, Victoria, Australia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- George Institute for Global Health, Imperial College London, London, UK
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Dickson KS, Kwabena Ameyaw E, Akpeke M, Mottey BE, Adde KS, Esia-Donkoh K. Socio-economic disadvantage and quality Antenatal Care (ANC) in Sierra Leone: Evidence from Demographic and Health Survey. PLoS One 2023; 18:e0280061. [PMID: 36634154 PMCID: PMC9836291 DOI: 10.1371/journal.pone.0280061] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Reduction of maternal mortality remains a global priority as highlighted by the third Sustainable Development Goal (SDG). This is critical in the case of Sierra Leone as the country is one of three (3) countries with the highest maternal mortality ratio globally, thus 1,120 per 100,000 live births. The approximate lifetime risk of maternal mortality in the country is 1 in 17, relative to 1 in 3,300 in high-income countries. These raise doubt about the quality of the continuum of maternal healthcare in the country, particularly antenatal care and as a result, the objective of the present study is to investigate the association between socio-economic disadvantage and quality antenatal care service utilisation as well as associated correlates in Sierra Leone. MATERIALS AND METHODS The study used data from the most recent Demographic and Health Survey (DHS) of Sierra Leone. Only women who had given birth in the five years preceding the survey were included, which is 6,028. Quality antenatal care was defined as receipt of recommended ANC services including uptake of recommended pregnancy drugs (e.g. Fansidar and iron supplement); injections (e.g. tetanus injection) and having some samples (e.g. blood and urine sample) and health status indicators (e.g. blood pressure) taken. An index was created from these indicators with scores ranging from 0 to 6. The scores 0 to 5 were labelled as "incomplete" and 6 was labelled as "complete" and this was used to create a dummy variable. In analysing the data, descriptive analysis was done using chi-square test as well as an inferential analysis using bivariate and multivariate models. RESULTS Socio-economic disadvantaged [1.46 (1.09, 1.95), place of residence [2.29 (1.43, 3.67)], frequency of listening to radio [1.58 (1.20, 2.09)], health insurance coverage [3.48 (1.40, 8.64)], getting medical help for self: permission to go [0.53(0.42, 0.69) were seen to have significant relationship with quality of ANC utilized by women during pregnancy. Also, women Mende ethnicity are more likely to utilise quality ANC compared to women from the Temne ethnicity [2.58 (1.79, 3.72)]. CONCLUSION Policy makers could consider measures to boost patronage of quality ANC in Sierra Leone by targeting the socio-economically disadvantaged women. Targeting these sub-groups with pro- maternal and child health (MCH) interventions would help Sierra Leone achieve Goal 3 of the SDGs.
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Affiliation(s)
- Kwamena Sekyi Dickson
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Edward Kwabena Ameyaw
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Tuen Mun, Hong Kong
| | - Mawulorm Akpeke
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Barbara Elorm Mottey
- Institute of Health Research, University of Health and Allied Sciences, Volta Region, Ghana
- Department of Environmental Health Sciences, University of Massachusetts, Amherst, Massachusetts, United States of America
| | - Kenneth Setorwu Adde
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
- * E-mail:
| | - Kobina Esia-Donkoh
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
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Kangbai DM, Bandoh DA, Manu A, Kangbai JY, Kenu E, Addo-Lartey A. Socio-economic determinants of maternal health care utilization in Kailahun District, Sierra Leone, 2020. BMC Pregnancy Childbirth 2022; 22:276. [PMID: 35365124 PMCID: PMC8976326 DOI: 10.1186/s12884-022-04597-z] [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: 01/01/2021] [Accepted: 03/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background Ascertaining the key determinants of maternal healthcare service utilization and their relative importance is critical to priority setting in policy development. Sierra Leone has one of the world’s highest maternal death ratios in the context of a weak health system. The objectives of this study were to determine; the level of utilization of Antenatal Care (ANC), Skilled Delivery Attendants (SDA), Postnatal Care (PNC) services, and factors that influence the utilization of these services. Methods We conducted a community-based cross-sectional study involving 554 women of reproductive age (15–49 years) who had at least one delivery in the last 3 years and lived in the Kailahun District, Sierra Leone from November 2019 to October 2020. Data were analysed using analysed using bivariate, multivariate and multinomial logistic regression models. Results The median age of respondents was 25 years (Q1 = 17 years, Q3 = 30 years). Eighty-nine percent (89%) had 4 or more ANC visits. Only 35.9% of women were delivered by SDA. Women residing in urban areas had over six-fold increased odds of utilizing SDA as compared to women residing in rural areas (AOR = 6.20, 95% CI = 3.61–10.63). Women whose husbands had a primary level of education had 2.38 times increased odds of utilizing SDA than women whose husbands had no education (AOR = 2.38, 95% CI = 1.30–4.35). Women that walked longer distances (30–60 min) to seek healthcare had 2.98 times increased odds of utilizing SBA than those that walked shorter distances (< 30 min) (AOR = 2.98, 95% CI = 1.67–5.33). Women who had a secondary/vocational level of education had 2.35 times increased odds of utilizing the standard PNC category as compared to those with no education (OR = 2.35, 95% CI = 1.19–4.63). Conclusion The majority of women had 4 or more ANC visits yet the use of skilled birth attendants was low. Urban residence and education were significantly associated with the use of the standard PNC category. To improve the utilization of maternal health care services, national healthcare policies should target the advancement of education, train skilled Maternal Healthcare (MHC) attendants, rural infrastructure, and the empowerment of women. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04597-z.
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Affiliation(s)
- Desmond Maada Kangbai
- Ghana Field Epidemiology and Laboratory Training Program, University of Ghana of School of Public Health, Legon, Accra, Ghana
| | - Delia Akosua Bandoh
- Ghana Field Epidemiology and Laboratory Training Program, University of Ghana of School of Public Health, Legon, Accra, Ghana
| | - Alexander Manu
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | | | - Ernest Kenu
- Ghana Field Epidemiology and Laboratory Training Program, University of Ghana of School of Public Health, Legon, Accra, Ghana
| | - Adolphina Addo-Lartey
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana.
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Utilisation of Skilled Birth Attendant in Low- and Middle-Income Countries: Trajectories and Key Sociodemographic Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010722. [PMID: 34682468 PMCID: PMC8535845 DOI: 10.3390/ijerph182010722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/08/2021] [Accepted: 10/09/2021] [Indexed: 11/26/2022]
Abstract
Reducing the maternal mortality ratio (MMR) in low- and middle-income countries (LMICs) remains a huge challenge. Maternal mortality is mostly attributed to low coverage of maternal health services. This study investigated the trajectories and predictors of skilled birth attendant (SBA) service utilisation in LMIC over the past two decades. The data was sourced from standard demographic and health surveys which included four surveys on women with livebirth/s from selected countries from two regions with a pooled sample of 56,606 Indonesian and 63,924 Nigerian respondents. Generalised linear models with quasibinomial family of distributions were fitted to investigate the association between SBA utilisation and sociodemographic factors. Despite a significant improvement in the last two decades in both countries, the change was slower than hope for, and inconsistent. Women who received antenatal care were more likely to use an SBA service. SBA service utilisation was significantly more prevalent amongst literate women in Indonesia (AOR = 1.39, 95% CI: 1.24–1.54) and Nigeria (AOR = 1.41, 95% CI: 1.31–1.53) than their counterparts. The disparity based on geographic region and social factors remained significant over time. Given the significant disparities in SBA utilisation, there is a strong need to focus on community- and district-level interventions that aim at increasing SBA utilisation.
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Caviglia M, Dell’Aringa M, Putoto G, Buson R, Pini S, Youkee D, Jambai A, Vandy MJ, Rosi P, Hubloue I, Della Corte F, Ragazzoni L, Barone-Adesi F. Improving Access to Healthcare in Sierra Leone: The Role of the Newly Developed National Emergency Medical Service. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9546. [PMID: 34574468 PMCID: PMC8472563 DOI: 10.3390/ijerph18189546] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 02/04/2023]
Abstract
We aim to evaluate whether the first National Emergency Medical Service (NEMS) improved access to hospital care for the people of Sierra Leone. We performed an interrupted time-series analysis to assess the effects of NEMS implementation on hospital admissions in 25 facilities. The analysis was also replicated separately for the area of Freetown and the rest of the country. The study population was stratified by the main Free Health Care Initiative (FHCI) categories of pregnant women, children under 5 years of age, and populations excluded from the FHCI. Finally, we calculated direct costs of the service. We report a 43% overall increase in hospital admissions immediately after NEMS inception (RR 1.43; 95% CI 1.2-1.61). Analyses stratified by FHCI categories showed a significant increase among pregnant women (RR 1.54; 95% CI 1.33-1.77) and among individuals excluded from the FHCI (RR 2.95; 95% CI 2.47-3.53). The observed effect was mainly due to the impact of NEMS on the rural districts. The estimated recurrent cost per ambulance ride and NEMS yearly cost per inhabitant were 124 and 0.45 USD, respectively. To our knowledge, this is the first nationwide study documenting the increase in access to healthcare services following the implementation of an ambulance-based medical service in a low-income country. Based on our results, NEMS was able to overcome the existing barriers of geographical accessibility and transport availability, especially in the rural areas of Sierra Leone.
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Affiliation(s)
- Marta Caviglia
- CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, 28100 Novara, Italy; (M.D.); (F.D.C.); (L.R.); (F.B.-A.)
| | - Marcelo Dell’Aringa
- CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, 28100 Novara, Italy; (M.D.); (F.D.C.); (L.R.); (F.B.-A.)
| | - Giovanni Putoto
- Research Section, Doctors with Africa CUAMM, 35121 Padua, Italy; (G.P.); (R.B.); (S.P.)
| | - Riccardo Buson
- Research Section, Doctors with Africa CUAMM, 35121 Padua, Italy; (G.P.); (R.B.); (S.P.)
| | - Sara Pini
- Research Section, Doctors with Africa CUAMM, 35121 Padua, Italy; (G.P.); (R.B.); (S.P.)
| | - Daniel Youkee
- School of Population Health and Environmental Sciences, King’s College London, London SE5 9NU, UK;
| | - Amara Jambai
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (A.J.); (M.J.V.)
| | - Matthew Jusu Vandy
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (A.J.); (M.J.V.)
| | - Paolo Rosi
- SUEM 118 Venezia, Azienda ULSS 3 Serenissima, 30174 Mestre, Italy;
| | - Ives Hubloue
- Research Group on Emergency and Disaster Medicine, Vrije Universiteit Brussels, 1050 Brussels, Belgium;
| | - Francesco Della Corte
- CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, 28100 Novara, Italy; (M.D.); (F.D.C.); (L.R.); (F.B.-A.)
| | - Luca Ragazzoni
- CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, 28100 Novara, Italy; (M.D.); (F.D.C.); (L.R.); (F.B.-A.)
| | - Francesco Barone-Adesi
- CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, 28100 Novara, Italy; (M.D.); (F.D.C.); (L.R.); (F.B.-A.)
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Amponsah E, Fusheini A, Adam A. Influence of information, education and communication on prenatal and skilled delivery in the Tano North District, Ghana: A cross-sectional study. Heliyon 2021; 7:e07245. [PMID: 34189302 PMCID: PMC8215216 DOI: 10.1016/j.heliyon.2021.e07245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/14/2021] [Accepted: 06/03/2021] [Indexed: 11/26/2022] Open
Abstract
Skilled birth attendance is considered an effective intervention to reduce maternal and early neonatal morbidity and mortality. Yet in Ghana, skilled birth attendance is said to be relatively low despite high antenatal attendance. In this study, we specifically assessed the influence of information, education and communication on prenatal and skilled delivery in the Tano North District of Ghana. A descriptive cross-sectional quantitative survey involving both closed and open-ended questionnaires were conducted among 393 women at three health facilities. The results showed skilled health personnel attended 94.1% of deliveries, which is higher than what has been reported in previous studies. Mothers with Senior High School Education were found to be 11.46 times more likely to be delivered by skilled birth attendant than those without formal education COR = 11.46, 95% (2.01-65.19) and this was statistically significant p = 0.006. There was also a significant association between information received by pregnant women and place of delivery (X2 = 20.85, P = 0.000 α = 0.05) in that the usefulness of information to mothers influenced their choice of health facility delivery. Marital status was also strongly correlated to being attended by skilled birth attendant (χ2 = 14.73, p = 0.005) as 0.4 times of mothers who were married were more likely to be attended by skilled birth attendants as compared to those that are single. COR = 0.005, 95% CI (0.00-0.36) and this was statistically significant p = 0.002. This study suggests the incorporation of IE&C into nursing training curriculum to orient students on the importance of IE&C so as to improve ANCs and skilled birth attendance further.
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Affiliation(s)
- Evelyn Amponsah
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
- Ghana Health Service, Disease Control Unit, Tano North District, Ahafo Region, Ghana
| | - Adam Fusheini
- Department of Preventive and Social Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
- Center for Health Literacy and Rural Health Promotion, Accra, Ghana
| | - Awolu Adam
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
- Center for Health Literacy and Rural Health Promotion, Accra, Ghana
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Laksono AD, Wulandari RD, Rukmini R. The determinant of healthcare childbirth among young people in Indonesia. J Public Health Res 2021; 10:1890. [PMID: 33553060 PMCID: PMC7856826 DOI: 10.4081/jphr.2021.1890] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/12/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Young people is a vulnerable period of the emergence of various problems that may occur especially to those who are pregnant. The study was aimed to analyze the determinants of healthcare childbirth among young people in Indonesia in 2017. Design and Methods: The samples of this study were young people (15-24 yo.) who labored in the last 5 years, and there were 3,235 female young people involved. The study analyzed some variables, such as childbirth healthcare, a type of residence, age, education, employment, marital, parity, wealth, insurance, the autonomy of family finances, the autonomy of health, knowledge of pregnancy danger signs, and ANC. The data were analyzed by binary logistic regression. Results: Young people in urban were 2.23 times more likely to attend healthcare childbirth than those in rural (95%CI 1.84-2.70). Young people who completed secondary education were 4.12 times more likely to undergo delivery care than no education (95% CI 1.51-11.23). The richest were 5.60 times more likely to experience delivery care than the poorest (95%CI 3.52-8.93). Health insurance gave 1.44 possibilities for undergoing labor and delivery care (95%CI 1.22-1.70). Besides, knowing the danger signs of pregnancy allowed 1.50 times the possibilities for them to access labor and delivery care (95%CI 1.27-1.78). Young people with ANC visits of ≥4 times had more 1.68 times possibilities for taking healthcare childbirth compared to those with that of <4 times (95%CI 1.38-2.06). Conclusions: The study concluded that the determinants of healthcare childbirth among female adolescents in Indonesia included a residence, education, wealth, insurance, knowledge of pregnancy danger signs, and ANC.
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Affiliation(s)
- Agung Dwi Laksono
- National Institute of Health Research and Development, Indonesia Ministry of Health, Jakarta
| | | | - Rukmini Rukmini
- National Institute of Health Research and Development, Indonesia Ministry of Health, Jakarta
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