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Ilesanmi BB, Solanke BL, Oni TO, Yinusa RA, Oluwatope OB, Oyeleye OJ. To what extent is antenatal care in public health facilities associated with delivery in public health facilities? Findings from a cross-section of women who had facility deliveries in Nigeria. BMC Public Health 2023; 23:820. [PMID: 37143016 PMCID: PMC10161441 DOI: 10.1186/s12889-023-15688-7] [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: 10/15/2022] [Accepted: 04/16/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Facility delivery remains an important public health issue in Nigeria. Studies have confirmed that antenatal care may improve the uptake of facility delivery. However, information is rarely available in Nigeria on the extent to which antenatal care in public health facilities is associated with delivery in public health facilities. The objective of the study was thus to examine the extent of the association between antenatal care in public health facilities and delivery in public health facilities in Nigeria. The study was guided by the Andersen behavioral model of health services use. METHODS The cross-sectional design was adopted. Data were extracted from the most recent Nigeria Demographic and Health Survey (NDHS). A sample of 9,015 women was analyzed. The outcome variable was the facility for delivery. The main explanatory variable was the antenatal care facility. The predisposing factors were maternal age, age at first birth, parity, exposure to mass media, and, religion. The enabling factors were household wealth, work status, partners' education, women's autonomy, health insurance, and, perception of distance to the health facility. The need factors were pregnancy wantedness, the number of antenatal care visits, and the timing of the first antenatal care. Statistical analyses were performed with the aid of Stata version 14. Two binary logistic regression models were fitted. RESULTS Findings showed that 69.6% of the women received antenatal care in public health facilities, while 91.6% of them subsequently utilized public health facilities for deliveries. The significant predisposing factors were age at first birth, parity, maternal education, and religion, while household wealth, work status, women's autonomy, and partners' education were the significant enabling factors. The timing of the first antenatal contact, pregnancy wantedness, and the number of antenatal care visits were the important need factors. CONCLUSION To a significant extent, antenatal care in public health facilities is associated with deliveries in public health facilities in Nigeria. It is imperative for governments in the country to take more steps to ensure the expanded availability of public health facilities in all parts of the country since their use for antenatal care is well-associated with their use for delivery care.
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Affiliation(s)
- Benjamin Bukky Ilesanmi
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Bola Lukman Solanke
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria.
- Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - Tosin Olajide Oni
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Rasheed Adebayo Yinusa
- Department of Demography and Social Statistics, Federal University, Birnin-Kebbi, Nigeria
| | - Omolayo Bukola Oluwatope
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
- National Centre for Technology Management, Obafemi Awolowo University, Ile-Ife, Nigeria
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Shiras T, Bradley SEK, Johns B, Cogswell H. Sources for and quality of neonatal care in 45 low- and middle-income countries. PLoS One 2022; 17:e0271490. [PMID: 35853018 PMCID: PMC9295978 DOI: 10.1371/journal.pone.0271490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 07/04/2022] [Indexed: 11/19/2022] Open
Abstract
Almost half of under-five deaths occur during the neonatal period. Delivery with a skilled attendant, adherence to essential newborn care (ENC) and postnatal care (PNC) standards, and immediate treatment of infections are essential to improve neonatal survival. This article uses Demographic and Health Survey data from 45 low- and middle-income countries to assess 1) levels of ENC and PNC that mothers and newborns receive and how this differs by place of delivery and 2) levels of and sources for care-seeking for neonates sick with fever. For five of the ten ENC and PNC indicators assessed, less than two-thirds of mothers and newborns received care in alignment with global standards. Adherence is higher in private facilities than public facilities for all indicators other than immediate breastfeeding and skin-to-skin contact. Except for immediate breastfeeding, adherence is lowest for newborns born at home with a skilled birth attendant (SBA). Socioeconomic disparities exist in access to skilled delivery and adherence to ENC and PNC, with the largest disparities among newborns delivered at home with a SBA. Private provider adherence to ENC and PNC standards was relatively high for newborns from the wealthiest families, indicating that meeting recommended guidelines is achievable. On average across the 45 countries, half of caregivers for neonates with fever sought care outside the home and 45 percent of those sought care from the private sector. There were substantial socioeconomic disparities in care-seeking for fever, but illness prevalence and sources of care seeking were consistent across wealth quintiles. Closing inequities in neonatal care and care seeking and ensuring that all families, including the poorest, can access high quality maternal and newborn care is crucial to ensure equity and accelerate reductions in neonatal and child mortality.
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Affiliation(s)
- Tess Shiras
- International Development Division, Abt Associates, Rockville, MD, United States of America
- * E-mail:
| | - Sarah E. K. Bradley
- International Development Division, Abt Associates, Rockville, MD, United States of America
| | - Benjamin Johns
- International Development Division, Abt Associates, Rockville, MD, United States of America
| | - Heather Cogswell
- International Development Division, Abt Associates, Rockville, MD, United States of America
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Fagbamigbe AF, Bello S, Salawu MM, Afolabi RF, Gbadebo BM, Adebowale AS. Trend and decomposition analysis of risk factors of childbirths with no one present in Nigeria, 1990-2018. BMJ Open 2021; 11:e054328. [PMID: 34887282 PMCID: PMC8663083 DOI: 10.1136/bmjopen-2021-054328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To assess the trend and decompose the determinants of delivery with no one present (NOP) at birth with an in-depth subnational analysis in Nigeria. DESIGN Cross-sectional. SETTING Nigeria, with five waves of nationally representative data in 1990, 2003, 2008, 2013 and 2018. PARTICIPANTS Women with at least one childbirth within 5 years preceding each wave of data collection. PRIMARY AND SECONDARY OUTCOME MEASURES The outcome of interest is giving birth with NOP at delivery defined as childbirth assisted by no one. Data were analysed using Χ2 and multivariate decomposition analyses at a 5% significance level. RESULTS The prevalence of having NOP at delivery was 15% over the studied period, ranges from 27% in 1990 to 11% in 2018. Overall, the prevalence of having NOP at delivery reduced significantly by 35% and 61% within 2003-2018 and 1990-2018, respectively (p<0.001). We found wide variations in NOP across the states in Nigeria. The highest NOP practice was in Zamfara (44%), Kano (40%) and Katsina (35%); while the practice was 0.1% in Bayelsa, 0.8% in Enugu, 0.9% in Osun and 1.1% in Imo state. The decomposition analysis of the changes in having NOP at delivery showed that 85.4% and 14.6% were due to differences in women's characteristics (endowment) and effects (coefficient), respectively. The most significant contributions to the changes were the decision-maker of healthcare utilisation (49%) and women educational status (24%). Only Gombe experienced a significant increase (p<0.05) in the level of having NOP between 2003 and 2018. CONCLUSION A long-term decreasing secular trend of NOP at delivery was found in Nigeria. NOP is more prevalent in the northern states than in the south. Achieving zero prevalence of NOP at delivery in Nigeria would require a special focus on healthcare utilisation, enhancing maternal education and healthcare utilisation decision-making power.
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Affiliation(s)
| | - Segun Bello
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Mobolaji M Salawu
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Rotimi F Afolabi
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
- Population and Health Research Entity, North-West University, Mmabatho, South Africa
| | - Babatunde M Gbadebo
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Ayo S Adebowale
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
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Uneke CJ, Sombie I, Uro-Chukwu HC, Johnson E. Developing equity-focused interventions for maternal and child health in Nigeria: an evidence synthesis for policy, based on equitable impact sensitive tool (EQUIST). Pan Afr Med J 2019; 34:158. [PMID: 32153698 PMCID: PMC7046112 DOI: 10.11604/pamj.2019.34.158.16622] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 08/12/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction Among the most critical health systems components that requires strengthening to improve maternal, newborn and child health (MNCH) outcomes in Nigeria is the concept of equity. UNICEF has designed the equitable impact sensitive tool (EQUIST) to enable policymakers improve equity in MNCH and reduce disparities between the most marginalized mothers and young children and the better-off. Methods Using the latest available DHS data sets, we conducted EQUIST situation and scenario analysis of MNCH outcomes in Nigeria by sub-national categorization, wealth and by residence. We then identified the intervention package, the bottlenecks and strategies to address them and the number of deaths avertible. Results EQUIST profile analysis showed that the number of under-five deaths was considerably higher among the poorest and rural population in Nigeria, and was highest in North-West region. Neonatal causes, malaria, pneumonia and diarrhoea were responsible for most of the under-five deaths. Highest maternal mortality was recorded in the North-West Nigeria. Ante-partum, intrapartum and postpartum haemorrhages and hypertensive disorder, were responsible for highest maternal deaths. EQUIST scenario analysis showed that an intervention package of insecticide treated net can avert more than 20,000 under-five deaths and delivery by skilled professionals can avert nearly 17,000 under-five deaths. While as many as 3,370 maternal deaths can be averted by deployment of skilled professionals. Conclusion Scaling up integrated packages of essential interventions across the continuum of care, addressing the human resource shortages in rural area and economic/social empowerment of women are policy recommendations that can improve MNCH outcomes in Nigeria.
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Affiliation(s)
- Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, PMB 053 Abakaliki, Nigeria
| | - Issiaka Sombie
- West African Health Organization, 175, Avenue Ouezzin Coulibaly, 01 BP 153 Bobo Dioulasso 01, Burkina Faso
| | | | - Ermel Johnson
- West African Health Organization, 175, Avenue Ouezzin Coulibaly, 01 BP 153 Bobo Dioulasso 01, Burkina Faso
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Solanke BL, Rahman SA. Multilevel analysis of factors associated with assistance during delivery in rural Nigeria: implications for reducing rural-urban inequity in skilled care at delivery. BMC Pregnancy Childbirth 2018; 18:438. [PMID: 30409121 PMCID: PMC6225672 DOI: 10.1186/s12884-018-2074-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/25/2018] [Indexed: 11/25/2022] Open
Abstract
Background Studies have observed rural-urban inequity in the use of skilled delivery in Nigeria. A number of studies have explicitly examined associated factors of assistance during delivery in rural areas. However, the studies so far conducted in rural Nigeria have investigated mainly individual-level characteristics with near exclusion of community-level characteristics. Also, most of the studies that have investigated community-level influence on use of maternal healthcare services in Nigeria did not isolate rural areas for specific research attention. The objective of this study was to investigate the individual-level and community-level characteristics associated with assistance during delivery in rural Nigeria. Methods The study analysed women data of 2013 Nigeria Demographic and Health Survey. A weighted sample size of 12,665 rural women was analysed. The outcome variable was assistance during delivery, dichotomised into ‘skilled assistance’ and ‘unskilled assistance’. The explanatory variables are selected individual-level characteristics (maternal education, parity, age at first birth, religion, healthcare decision, employment status, access to mass media, and means of transportation); and selected community-level characteristics (community literacy level, community childcare burden, proportion of women employed outside agriculture, proportion of women who perceived distance to facility as a big problem, community poverty level, and geographical region). The mixed-effects logistic regression was applied. Results During the most recent deliveries, 23.0% of rural women utilised skilled assistance compared with 77.0% who utilised unskilled assistance. Maternal education, parity, religion, healthcare decision, access to mass media, and means of transportation were the individual-level characteristics that revealed significant effects on the likelihood of utilising skilled assistance during delivery, while community literacy level, community poverty level, community perception of distance to health facility, and geographic region were the community-level characteristics that revealed significant effects on the odds of using skilled assistance during delivery. Results of Intra-Class Correlation (ICC) supported significant community-level effects on the likelihood of using skilled assistance during delivery. Conclusions Assistance during delivery is influenced by individual-level and community-level characteristics. Health policies and programmes seeking to reduce rural-urban inequity in skilled delivery should endeavour to identify and address important factors at both the individual and community levels of the social environment.
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Affiliation(s)
- Bola Lukman Solanke
- Department of Demography and Social Statistics, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - Semiu Adebayo Rahman
- Department of Demography and Social Statistics, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
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Målqvist M, Pun A, Raaijmakers H, Kc A. Persistent inequity in maternal health care utilization in Nepal despite impressive overall gains. Glob Health Action 2018; 10:1356083. [PMID: 28841091 PMCID: PMC5645707 DOI: 10.1080/16549716.2017.1356083] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: Maternal health care utilization is at the core of global public health provision and an area of focus in the now-concluded Millennium Development Goal agenda. Objective: This study aims to examine trends in maternal health care utilization over the last 15 years in Nepal, focusing on coverage and equity. Methods: This paper used data from the Demographic Health Survey (DHS) 2001, 2006 and 2011 and Multiple Indicator Cluster Survey (MICS), 2014. Coverage rates were calculated and logistic regression models used to examine inequity. Results: Impressive gains were found in antenatal care (ANC) attendance, which increased from nearly half of women attending (49%) in 2001 to 88% in 2014, and the rate of facility delivery increased from just 7–44%. This development did not, however, influence the equity gap in ANC and skilled attendance at birth, as women from low socioeconomic backgrounds were six times more likely to deliver without skilled assistance than those from high socioeconomic backgrounds (AdjOR 6.38 CI 95% 4.57–8.90) in 2014. Conclusion: These persistent equity gaps call for targeted interventions focusing on the most disadvantaged and vulnerable women in order to achieve the new Sustainable Development Goal of universal health coverage.
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Affiliation(s)
- Mats Målqvist
- a International Maternal and Child Health, Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | - Asha Pun
- b UN Health Section , UNICEF , Pulchowk , Nepal
| | | | - Ashish Kc
- a International Maternal and Child Health, Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden.,b UN Health Section , UNICEF , Pulchowk , Nepal
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Dennis ML, Benova L, Owolabi OO, Campbell OMR. Meeting need vs. sharing the market: a systematic review of methods to measure the use of private sector family planning and childbirth services in sub-Saharan Africa. BMC Health Serv Res 2018; 18:699. [PMID: 30200964 PMCID: PMC6131793 DOI: 10.1186/s12913-018-3514-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/30/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Ensuring universal access to maternal and reproductive health services is critical to the success of global efforts to reduce poverty and inequality. Engaging private providers has been proposed as a strategy for increasing access to healthcare in low- and middle-income countries; however, little consensus exists on how to estimate the extent of private sector use. Using research from sub-Saharan Africa, this study systematically compares and critiques quantitative measures of private sector family planning and childbirth service use and synthesizes evidence on the role of the private sector in the region. METHODS We conducted a systematic review of the Medline, Global Health, and Popline databases. All studies that estimated use of private sector of family planning or childbirth services in one or more sub-Saharan African countries were included in this review. For each study, we extracted data on the key study outcomes and information on the methods used to estimate private sector use. RESULTS Fifty-three papers met our inclusion criteria; 31 provided outcomes on family planning, and 26 provided childbirth service outcomes. We found substantial methodological variation between studies; for instance, while some reported on service use from any private sector source, others distinguished private sector providers either by their profit orientation or position within or outside the formal medical sector. Additionally, studies measured the use of private sector services differently, with some estimating the proportion of need met by the private sector and others examining the sector's share among the market of service users. Overall, the estimates suggest that the private sector makes up a considerable portion (> 20%) of the market for family planning and childbirth care, but its role in meeting women's need for these services is fairly low (< 10%). CONCLUSIONS Many studies have examined the extent of private sector family planning and childbirth service provision; however, inconsistent methodologies make it difficult to compare results across studies and contexts. Policymakers should consider the implications of both private market share and coverage estimates, and be cautious in interpreting data on the scale of private sector health service provision without a clear understanding of the methodology.
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Affiliation(s)
- Mardieh L. Dennis
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Lenka Benova
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | | | - Oona M. R. Campbell
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Yan LD, Mwale J, Straitz S, Biemba G, Bhutta Z, Ross JF, Mwananyanda L, Nambao M, Ngwakum P, Genovese E, Banda B, Akseer N, Yeboah-Antwi K, Rockers PC, Hamer DH. Equity dimensions of the availability and quality of reproductive, maternal and neonatal health services in Zambia. Trop Med Int Health 2018; 23:433-445. [PMID: 29457318 DOI: 10.1111/tmi.13043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To assess how quality and availability of reproductive, maternal, neonatal (RMNH) services vary by district wealth and urban/rural status in Zambia. METHODS We conducted a retrospective analysis of data from the Millennium Development Goal Acceleration Initiative baseline assessment of 117 health facilities in 9 districts. Quality was assessed through a composite score of 23 individual RMNH indicators, ranging from 0 to 1. Availability was evaluated by density of providers and facilities. Districts were divided into wealth groups based on the multidimensional poverty index (MPI). Relative inequity was calculated using the concentration index for quality indicators (positive favours rich, negative favours poor). Multivariable linear regression was performed for the dependent variable composite quality indicator using MPI, urban/rural, and facility level of care as independent variables. RESULTS 13 hospitals, 85 health centres and 19 health posts were included. The RMNH composite quality indicator was 0.64. Availability of facilities and providers was universally low. The concentration index for the composite quality indicator was -0.015 [-0.043, 0.013], suggesting no clustering to favour either rich or poor districts. Rich districts had the highest absolute numbers of health facilities and providers, but lowest numbers per facility per 1 000 000 population. Urban districts had slightly better service quality, but not availability. Using regression analysis, only facility level of care was significantly associated with quality outcome. CONCLUSIONS Composite quality of RMNH services did not vary by district wealth, but was slightly higher in urban districts. The availability data suggest that the higher population in richer districts outpaces health infrastructure.
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Affiliation(s)
- Lily D Yan
- Department of Medicine, Boston Medical Center, Boston, MA, USA.,Department of Global Health and Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA
| | | | - Samantha Straitz
- Department of Global Health and Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA
| | - Godfrey Biemba
- National Health Research Authority, Ministry of Health, Lusaka, Zambia
| | - Zulfiqar Bhutta
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.,Centre for Global Child Health, SickKids Hospital, Toronto, ON, Canada
| | - Julia F Ross
- Delegation of the European Union in Zambia, Lusaka, Zambia
| | | | - Mary Nambao
- Maternal and Child Health, Ministry of Health, Lusaka, Zambia
| | | | | | - Bowen Banda
- Zambian Centre for Applied Health Research and Development, Lusaka, Zambia
| | - Nadia Akseer
- Centre for Global Child Health, SickKids Hospital, Toronto, ON, Canada
| | - Kojo Yeboah-Antwi
- Department of Global Health and Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA
| | - Peter C Rockers
- Department of Global Health and Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA
| | - Davidson H Hamer
- Department of Medicine, Boston Medical Center, Boston, MA, USA.,Department of Global Health and Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA.,Zambian Centre for Applied Health Research and Development, Lusaka, Zambia
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Chitalu CC, Steven K. Assessing regional variations in the effect of the removal of user fees on facility-based deliveries in rural Zambia. Afr Health Sci 2017; 17:1185-1196. [PMID: 29937891 PMCID: PMC5870268 DOI: 10.4314/ahs.v17i4.28] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Maternal health remains a concern in sub-Saharan Africa, where maternal mortality averages 680 per 100,000 live births and almost 50% of the approximately 350,000 annual maternal deaths occur. Improving access to skilled birth assistance is paramount to reducing this average, and user fee reductions could help. Objective The aim of this research was to analyse the effect of user fee removal in rural areas of Zambia on the use of health facilities for childbirth. The analysis incorporates supply-side factors, including quantitative measures of service quality in the assessment. Method The analysis uses quarterly longitudinal data covering 2003 (q1)-2008 (q4) and controls for unobserved heterogeneity, spatial dependence and quantitative supply-side factors within an Interrupted Time Series design. Results User fee removal was found to initially increase aggregate facility-based deliveries. Drug availability, the presence of traditional birth attendants, social factors and cultural factors also influenced facility-based deliveries at the national level. Conclusion Although user fees matter, to a degree, service quality is a relatively more important contributor to the promotion of facility-based deliveries. Thus, in the short-term, strengthening and improving community-based interventions could lead to further increases in facility-based deliveries.
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Altman R, Sidney K, De Costa A, Vora K, Salazar M. Is Institutional Delivery Protective Against Neonatal Mortality Among Poor or Tribal Women? A Cohort Study From Gujarat, India. Matern Child Health J 2016; 21:1065-1072. [PMID: 28035634 PMCID: PMC5391377 DOI: 10.1007/s10995-016-2202-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives In low-income settings, neonatal mortality rates (NMR) are higher among socioeconomically disadvantaged groups. Institutional deliveries have been shown to be protective against neonatal mortality. In Gujarat, India, the access of disadvantaged women to institutional deliveries has increased. However, the impact of increased institutional delivery on NMR has not been studied here. This paper examined if institutional childbirth is associated with lower NMR among disadvantaged women in Gujarat, India. Methods A community-based prospective cohort of pregnant women was followed in three districts in Gujarat, India (July 2013–November 2014). Two thousand nine hundred and nineteen live births to disadvantaged women (tribal or below poverty line) were included in the study. Data was analyzed using multivariable logistic regression. Results The overall NMR was 25 deaths per 1000 live births. Multivariable analysis showed that institutional childbirth was protective against neonatal mortality only among disadvantaged women with obstetric complications during delivery. Among mothers with obstetric complications during delivery, those who gave birth in a private or public facility had significantly lower odds of having a neonatal death than women delivering at home (AOR 0.07 95% CI 0.01–0.45 and AOR 0.03, 95% CI 0.00–0.33 respectively). Conclusions for Practice Our findings highlight the crucial role of institutional delivery to prevent neonatal deaths among those born to disadvantaged women with complications during delivery in this setting. Efforts to improve disadvantaged women’s access to good quality obstetric care must continue in order to further reduce the NMR in Gujarat, India.
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Affiliation(s)
- Rebecca Altman
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Kristi Sidney
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Ayesha De Costa
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of Reproductive and Child Health, Indian Institute of Public Health, Gandhinagar, Ahmedabad, Gujarat India
| | - Kranti Vora
- Department of Reproductive and Child Health, Indian Institute of Public Health, Gandhinagar, Ahmedabad, Gujarat India
| | - Mariano Salazar
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Millogo T, Musenge E, Azongo DK, Kouanda S, Oduro AR. Trends and changes in home deliveries in Kassena-Nankana districts in northern Ghana: Results from repeated cross-sectional surveys. Int J Gynaecol Obstet 2016; 135 Suppl 1:S33-S38. [PMID: 27836082 DOI: 10.1016/j.ijgo.2016.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate trends and changes in home deliveries in northern Ghana following the implementation of interventions targeting common barriers to utilization of health services. METHODS Data collected through repeated cross-sectional surveys conducted in the Kassena-Nankana east and west districts from 2003-2009 were used in a secondary analysis. All childbirths that occurred in this period were included. Univariate time series were used to describe trends in home deliveries. Significant trends were investigated using the χ2 test for trends, and changes in inequalities across subgroups were assessed by fitting simple linear regressions. RESULTS A total of 25 539 deliveries were recorded, of which 58.1% occurred at home. The incidence of home deliveries declined from 69.1% in 2003 to 36.5% in 2009 (P<0.001). This declining pattern was consistently observed within all subgroups defined by wealth index, and educational and residential status. Larger declines were observed in poor and rural residents compared with rich and urban residents (P<0.001). CONCLUSION The incidence of home deliveries halved during the study period and there was a significant reduction in previous inequalities.
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Affiliation(s)
- Tieba Millogo
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; African Institute of Public Health, Ouagadougou, Burkina Faso.
| | - Eustasius Musenge
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Seni Kouanda
- African Institute of Public Health, Ouagadougou, Burkina Faso; Research Institute of Health Sciences, Ouagadougou, Burkina Faso
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Diamond-Smith N, Thet MM, Khaing EE, Sudhinaraset M. Delivery and postpartum practices among new mothers in Laputta, Myanmar: intersecting traditional and modern practices and beliefs. CULTURE, HEALTH & SEXUALITY 2016; 18:1054-1066. [PMID: 27212423 DOI: 10.1080/13691058.2016.1144792] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Myanmar is witnessing increased access to modern maternity care, along with shifting norms and practices. Past research has documented low rates of facility-based deliveries in the country, along with adverse maternal and child health outcomes. Research has also documented diverse traditional practices in the postpartum period, related to maternity care and maternal food intake. Through 34 qualitative interviews with women who recently gave birth and their mothers-in-law in one township in Myanmar (Laputta), we explore factors influencing decision-making around postpartum care and the practices that women engage in. We find that women use both modern and traditional providers because different types of providers play particular roles in the delivery and postpartum period. Despite knowledge of about healthy foods to eat postpartum, many women restrict the intake of certain foods, and mothers-in-laws' beliefs in these practices are particularly strong. Findings suggest that women and their families are balancing two different sets of practices and beliefs, which at times come in conflict. Educational campaigns and programmes should address both modern and traditional beliefs and practices to help women be better able to access safe care and improve their own and their children's health.
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Affiliation(s)
- Nadia Diamond-Smith
- a Global Health Group/UCSF Global Health Sciences , University of California , San Francisco , USA
| | - May Me Thet
- b Population Services International , Yangon , Myanmar
| | - Ei Ei Khaing
- b Population Services International , Yangon , Myanmar
| | - May Sudhinaraset
- a Global Health Group/UCSF Global Health Sciences , University of California , San Francisco , USA
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Grépin KA. Private Sector An Important But Not Dominant Provider Of Key Health Services In Low- And Middle-Income Countries. Health Aff (Millwood) 2016; 35:1214-21. [DOI: 10.1377/hlthaff.2015.0862] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Karen A. Grépin
- Karen A. Grépin ( ) is an associate professor in the Department of Health Sciences, Wilfred Laurier University, in Waterloo, Ontario
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Pomeroy AM, Koblinsky M, Alva S. Who gives birth in private facilities in Asia? A look at six countries. Health Policy Plan 2016; 29 Suppl 1:i38-47. [PMID: 25012797 PMCID: PMC4095919 DOI: 10.1093/heapol/czt103] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Over the past two decades, multilateral organizations have encouraged increased engagement with private healthcare providers in developing countries. As these efforts progress, there are concerns regarding how private delivery care may effect maternal health outcomes. Currently available data do not allow for an in-depth study of the direct effect of increasing private sector use on maternal health across countries. As a first step, however, we use demographic and health surveys (DHS) data to (1) examine trends in growth of delivery care provided by private facilities and (2) describe who is using the private sector within the healthcare system. As Asia has shown strong increases in institutional coverage of delivery care in the last decade, we will examine trends in six Asian countries. We hypothesize that if the private sector competes for clients based on perceived quality, their clientele will be wealthier, more educated and live in an area where there are enough health facilities to allow for competition. We test this hypothesis by examining factors of socio-demographic, economic and physical access and actual/perceived need related to a mother's choice to deliver in a health facility and then, among women delivering in a facility, their use of a private provider. Results show a significant trend towards greater use of private sector delivery care over the last decade. Wealth and education are related to private sector delivery care in about half of our countries, but are not as universally related to use as we would expect. A previous private facility birth predicted repeat private facility use across nearly all countries. In two countries (Cambodia and India), primiparity also predicted private facility use. More in-depth work is needed to truly understand the behaviour of the private sector in these countries; these results warn against making generalizations about private sector delivery care.
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Affiliation(s)
- Amanda M Pomeroy
- John Snow Inc., San Francisco, CA, USA, United States Agency for International Development, 1300 Pennsylvania Ave NW, Washington, DC 20004, USA and John Snow Inc., 1616 N. Fort Myer Dr, 16th Floor, Arlington, VA 22209
| | - Marge Koblinsky
- John Snow Inc., San Francisco, CA, USA, United States Agency for International Development, 1300 Pennsylvania Ave NW, Washington, DC 20004, USA and John Snow Inc., 1616 N. Fort Myer Dr, 16th Floor, Arlington, VA 22209
| | - Soumya Alva
- John Snow Inc., San Francisco, CA, USA, United States Agency for International Development, 1300 Pennsylvania Ave NW, Washington, DC 20004, USA and John Snow Inc., 1616 N. Fort Myer Dr, 16th Floor, Arlington, VA 22209
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15
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Joseph G, da Silva ICM, Wehrmeister FC, Barros AJD, Victora CG. Inequalities in the coverage of place of delivery and skilled birth attendance: analyses of cross-sectional surveys in 80 low and middle-income countries. Reprod Health 2016; 13:77. [PMID: 27316970 PMCID: PMC4912761 DOI: 10.1186/s12978-016-0192-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 06/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Having a health worker with midwifery skills present at delivery is one of the key interventions to reduce maternal and newborn mortality. We sought to estimate the frequencies of (a) skilled birth attendant coverage, (b) institutional delivery, and (c) the combination of place of delivery and type of attendant, in LMICs. METHODS National surveys (DHS and MICS) performed in 80 LMICs since 2005 were analyzed to estimate these four categories of delivery care. Results were stratified by wealth quintile based on asset indices, and by urban/rural residence. The combination of place of delivery and type of attendant were also calculated for seven world regions. RESULTS The proportion of institutional SBA deliveries was above 90 % in 25 of the 80 countries, and below 40 % in 11 countries. A strong positive correlation between SBA and institutional delivery coverage (rho: 0.97, p <0,001) was observed. Eight countries had over 10 % of home SBA deliveries, and two countries had over 10 % of institutional non-SBA deliveries. Except for South Asia, all regions had over 80 % of urban deliveries in the institutional SBA category, but in rural areas, only two regions (CEE & CIS, Middle East & North Africa) presented average coverage above 80 %. In all regions, institutional SBA deliveries were over 80 % in the richest quintile. Home SBA deliveries were more common in rural than in urban areas, and in the poorest quintiles in all regions. Facility non-SBA deliveries also tended to be more common in rural areas and among the poorest. CONCLUSION Four different categories of delivery assistance were identified worldwide. Pro-urban and pro-rich inequalities were observed for coverage of institutional SBA deliveries.
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Affiliation(s)
- Gary Joseph
- International Center for Equity in Health, Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3o andar, Pelotas, RS 96020-220 Brazil
| | - Inácio Crochemore Mohnsam da Silva
- International Center for Equity in Health, Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3o andar, Pelotas, RS 96020-220 Brazil
| | - Fernando C. Wehrmeister
- International Center for Equity in Health, Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3o andar, Pelotas, RS 96020-220 Brazil
| | - Aluísio J. D. Barros
- International Center for Equity in Health, Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3o andar, Pelotas, RS 96020-220 Brazil
| | - Cesar G. Victora
- International Center for Equity in Health, Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3o andar, Pelotas, RS 96020-220 Brazil
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Duc NHC, Nakamura K, Kizuki M, Seino K, Rahman M. Trends in inequalities in utilization of reproductive health services from 2000 to 2011 in Vietnam. J Rural Med 2015; 10:65-78. [PMID: 26705431 PMCID: PMC4689735 DOI: 10.2185/jrm.2902] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 09/25/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study aimed to examine changes in utilization of reproductive health services by wealth status from 2000 to 2011 in Vietnam. METHODS Data from the Vietnam Multiple Indicator Cluster Surveys in 2000, 2006, and 2011 were used. The subjects were 550, 1023, and 1363 women, respectively, aged between 15 and 49 years who had given birth in the previous one or two years. The wealth index, a composite measure of a household's ownership of selected assets, materials used for housing construction, and types of water access and sanitation facilities, was used as a measure of wealth status. Main utilization indicators were utilization of antenatal care services, receipt of a tetanus vaccine, receipt of blood pressure measurement, blood examination and urine examination during antenatal care, receipt of HIV testing, skilled birth attendance at delivery, health-facility-based delivery, and cesarean section delivery. Inequalities by wealth index were measured by prevalence ratios, concentration indices, and multivariable adjusted regression coefficients. RESULTS Significant increase in overall utilization was observed in all indicators (all p < 0.001). The concentration indices were 0.19 in 2000 and 0.06 in 2011 for antenatal care, 0.10 in 2000 and 0.06 in 2011 for tetanus vaccination, 0.23 in 2000 and 0.08 in 2011 for skilled birth attendance, 0.29 in 2006 and 0.12 in 2011 for blood examination, and 0.18 in 2006 and 0.09 in 2011 for health-facility-based delivery. The multivariable adjusted regression coefficients of reproductive health service utilization by wealth category were 0.06 in 2000 and 0.04 in 2011 for antenatal care, 0.07 in 2000 and 0.05 in 2011 for skilled birth attendance, and 0.07 in 2006 and 0.05 in 2011 for health-facility-based delivery. CONCLUSIONS More women utilized reproductive health services in 2011 than in 2000. Inequality by wealth status in utilization of antenatal care, skilled birth attendance, and health-facility-based delivery had been reduced.
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Affiliation(s)
- Nguyen Huu Chau Duc
- Department of Global Health Promotion, Division of Public
Health, Graduate School of Tokyo Medical and Dental University, Japan
- Department of Pediatrics, Hue University of Medicine and
Pharmacy, Vietnam
| | - Keiko Nakamura
- Department of Global Health Promotion, Division of Public
Health, Graduate School of Tokyo Medical and Dental University, Japan
| | - Masashi Kizuki
- Department of Global Health Promotion, Division of Public
Health, Graduate School of Tokyo Medical and Dental University, Japan
| | - Kaoruko Seino
- Department of Global Health Promotion, Division of Public
Health, Graduate School of Tokyo Medical and Dental University, Japan
| | - Mosiur Rahman
- Department of Global Health Promotion, Division of Public
Health, Graduate School of Tokyo Medical and Dental University, Japan
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Benova L, Macleod D, Footman K, Cavallaro F, Lynch CA, Campbell OMR. Role of the private sector in childbirth care: cross-sectional survey evidence from 57 low- and middle-income countries using Demographic and Health Surveys. Trop Med Int Health 2015; 20:1657-73. [PMID: 26412496 DOI: 10.1111/tmi.12598] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Maternal mortality rates have decreased globally but remain off track for Millennium Development Goals. Good-quality delivery care is one recognised strategy to address this gap. This study examines the role of the private (non-public) sector in providing delivery care and compares the equity and quality of the sectors. METHODS The most recent Demographic and Health Survey (2000-2013) for 57 countries was used to analyse delivery care for most recent birth among >330 000 women. Wealth quintiles were used for equity analysis; skilled birth attendant (SBA) and Caesarean section rates served as proxies for quality of care in cross-sectoral comparisons. RESULTS The proportion of women who used appropriate delivery care (non-facility with a SBA or facility-based births) varied across regions (49-84%), but wealth-related inequalities were seen in both sectors in all regions. One-fifth of all deliveries occurred in the private sector. Overall, 36% of deliveries with appropriate care occurred in the private sector, ranging from 9% to 46% across regions. The presence of a SBA was comparable between sectors (≥93%) in all regions. In every region, Caesarean section rate was higher in the private compared to public sector. The private sector provided between 13% (Latin America) and 66% (Asia) of Caesarean section deliveries. CONCLUSION This study is the most comprehensive assessment to date of coverage, equity and quality indicators of delivery care by sector. The private sector provided a substantial proportion of delivery care in low- and middle-income countries. Further research is necessary to better understand this heterogeneous group of providers and their potential to equitably increase the coverage of good-quality intrapartum care.
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Affiliation(s)
- Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - David Macleod
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Katharine Footman
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Francesca Cavallaro
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Caroline A Lynch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Al Dahdah M, Desgrées Du Loû A, Méadel C. Mobile health and maternal care: A winning combination for healthcare in the developing world? HEALTH POLICY AND TECHNOLOGY 2015. [DOI: 10.1016/j.hlpt.2015.04.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Okafor II, Arinze-Onyia SU, Ohayi S, Onyekpa JI, Ugwu EO. Audit of Childbirth Emergency Referrals by Trained Traditional Birth Attendants in Enugu, Southeast, Nigeria. Ann Med Health Sci Res 2015; 5:305-10. [PMID: 26229721 PMCID: PMC4512125 DOI: 10.4103/2141-9248.160180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: The essence of training traditional birth attendants (TBAs) is to attend to women in uncomplicated labor and to refer them immediately to hospitals when complications develop. Aim: The aim was to audit childbirth emergency referrals by trained TBAs to a specialist hospital in Enugu, Nigeria. Subjects and Methods: A retrospective study of 205 childbirth emergencies referred to Semino Hospital and Maternity (SHM), Enugu by trained TBAs from August 1, 2011 to January 31, 2014. Data analysis was descriptive and inferential at 95% confidence level. Results: Most of the patients (185/205, 90.2%) were married and (100/205, 48.8%) had earlier booked for antenatal care in formal health facilities. There were obstetric danger signs or previous bad obstetric histories (pregnancies with unfavorable outcome) in 110 (110/205, 53.7%) women on admission at SHM. One hundred and fifteen (115/205, 56.1%) women walked into the hospital by themselves while 50 (50/205, 24.39%) could not walk. The fetal heart sounds were normal in 94 (94/205, 45.6%), abnormal in 65 (65/205, 31.8%) and absent in 42 (42/205, 20.4%) of the women on admission. Five healthy babies were delivered by the TBAs before referring their mothers. Delays of more than 12 h had occurred in 155 (155/205, 76.6%) of the women before referrals. Prolonged labor (100/205, 48.8%), obstructed labor (40/205, 19.5%), attempted vaginal birth after previous cesarean delivery (40/205, 19.5%) and malpresentation (30/205, 14.6%) were the common indications for referrals. The maternal mortality and perinatal mortality ratios were 610/100,000 live births and 228/1000 total births respectively. Conclusion: Delays at TBA centers are common before referral and most patients are referred in poor clinical state. Further training and re-training of the TBAs with more emphasis on recognition of obstetric danger signs and bad obstetric histories may help in screening high-risk patients for prompt referral to hospitals before complications develop.
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Affiliation(s)
- I I Okafor
- Department of Obstetrics and Gynecology, College of Medicine, Enugu State University of Science and Technology, Abakpa Nike, Enugu, Nigeria ; Semino Hospital and Maternity, Abakpa Nike, Nigeria
| | - S U Arinze-Onyia
- Department of Community Medicine, College of Medicine, Enugu State University of Science and Technology, Enugu, Nigeria
| | - Sar Ohayi
- Department of Histopathology, College of Medicine, Enugu State University of Science and Technology, Enugu, Nigeria
| | - J I Onyekpa
- Semino Hospital and Maternity, Abakpa Nike, Nigeria
| | - E O Ugwu
- Department of Obstetrics and Gynecology, College of Medicine, University of Nigeria Enugu Campus/University of Nigeria Teaching Hospital Ituku/Ozalla, Enugu, Nigeria
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Waiswa P, Akuze J, Peterson S, Kerber K, Tetui M, Forsberg BC, Hanson C. Differences in essential newborn care at birth between private and public health facilities in eastern Uganda. Glob Health Action 2015; 8:24251. [PMID: 25843495 PMCID: PMC4385204 DOI: 10.3402/gha.v8.24251] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 11/06/2014] [Accepted: 11/12/2014] [Indexed: 11/14/2022] Open
Abstract
Background In Uganda and elsewhere, the private sector provides an increasing and significant proportion of maternal and child health services. However, little is known whether private care results in better quality services and improved outcomes compared to the public sector, especially regarding care at the time of birth. Objective To describe the characteristics of care-seekers and assess newborn care practices and services received at public and private facilities in rural eastern Uganda. Design Within a community-based maternal and newborn care intervention with health systems strengthening, we collected data from mothers with infants at baseline and endline using a structured questionnaire. Descriptive, bivariate, and multivariate data analysis comparing nine newborn care practices and three composite newborn care indicators among private and public health facilities was conducted. Results The proportion of women giving birth at private facilities decreased from 25% at baseline to 17% at endline, whereas overall facility births increased. Private health facilities did not perform significantly better than public health facilities in terms of coverage of any essential newborn care interventions, and babies were more likely to receive thermal care practices in public facilities compared to private (68% compared to 60%, p=0.007). Babies born at public health facilities received an average of 7.0 essential newborn care interventions compared to 6.2 at private facilities (p<0.001). Women delivering in private facilities were more likely to have higher parity, lower socio-economic status, less education, to seek antenatal care later in pregnancy, and to have a normal delivery compared to women delivering in public facilities. Conclusions In this setting, private health facilities serve a vulnerable population and provide access to service for those who might not otherwise have it. However, provision of essential newborn care practices was slightly lower in private compared to public facilities, calling for quality improvement in both private and public sector facilities, and a greater emphasis on tracking access to and quality of care in private sector facilities.
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Affiliation(s)
- Peter Waiswa
- Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda.,Iganga-Mayuge Health Demographic Surveillance Site, Iganga-Mayuge, Uganda;
| | - Joseph Akuze
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Stefan Peterson
- Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda.,International Maternal and Child Health Unit, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Kate Kerber
- Saving Newborn Lives, Save the Children, Cape Town, South Africa
| | - Moses Tetui
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Birger C Forsberg
- Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Claudia Hanson
- Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Kerber K, Peterson S, Waiswa P. Special issue: newborn health in Uganda. Glob Health Action 2015; 8:27574. [PMID: 25843501 PMCID: PMC4385224 DOI: 10.3402/gha.v8.27574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Stefan Peterson
- Makerere University, Kampala, Uganda
- Karolinska Institutet, Stockholm, Sweden
- Uppsala University, Uppsala, Sweden
- Iganga/Mayuge Health Demographic Surveillance Site, Kampala, Uganda
| | - Peter Waiswa
- Makerere University, Kampala, Uganda
- Karolinska Institutet, Stockholm, Sweden
- Iganga/Mayuge Health Demographic Surveillance Site, Kampala, Uganda
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Footman K, Benova L, Goodman C, Macleod D, Lynch CA, Penn-Kekana L, Campbell OMR. Using multi-country household surveys to understand who provides reproductive and maternal health services in low- and middle-income countries: a critical appraisal of the Demographic and Health Surveys. Trop Med Int Health 2015; 20:589-606. [PMID: 25641212 PMCID: PMC4409817 DOI: 10.1111/tmi.12471] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The Demographic and Health Surveys (DHS) are a vital data resource for cross-country comparative analyses. This study is part of a set of analyses assessing the types of providers being used for reproductive and maternal health care across 57 countries. Here, we examine some of the challenges encountered using DHS data for this purpose, present the provider classification we used, and provide recommendations to enable more detailed and accurate cross-country comparisons of healthcare provision. METHODS We used the most recent DHS surveys between 2000 and 2012; 57 countries had data on family planning and delivery care providers and 47 countries had data on antenatal care. Every possible response option across the 57 countries was listed and categorised. We then developed a classification to group provider response options according to two key dimensions: clinical nature and profit motive. RESULTS We classified the different types of maternal and reproductive healthcare providers, and the individuals providing care. Documented challenges encountered during this process were limitations inherent in household survey data based on respondents' self-report; conflation of response options in the questionnaire or at the data processing stage; category errors of the place vs. professional for delivery; inability to determine whether care received at home is from the public or private sector; a large number of negligible response options; inconsistencies in coding and analysis of data sets; and the use of inconsistent headings. CONCLUSIONS To improve clarity, we recommend addressing issues such as conflation of response options, data on public vs. private provider, inconsistent coding and obtaining metadata. More systematic and standardised collection of data would aid international comparisons of progress towards improved financial protection, and allow us to better characterise the incentives and commercial nature of different providers.
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Affiliation(s)
- K Footman
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - L Benova
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - C Goodman
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - D Macleod
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - C A Lynch
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - L Penn-Kekana
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - O M R Campbell
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
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Sen G, Govender V. Sexual and reproductive health and rights in changing health systems. Glob Public Health 2014; 10:228-42. [PMID: 25536851 PMCID: PMC4318007 DOI: 10.1080/17441692.2014.986161] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 11/06/2014] [Indexed: 11/17/2022]
Abstract
Sexual and reproductive health and rights (SRHR) are centrally important to health. However, there have been significant shortcomings in implementing SRHR to date. In the context of health systems reform and universal health coverage/care (UHC), this paper explores the following questions. What do these changes in health systems thinking mean for SRHR and gender equity in health in the context of renewed calls for increased investments in the health of women and girls? Can SRHR be integrated usefully into the call for UHC, and if so how? Can health systems reforms address the continuing sexual and reproductive ill health and violations of sexual and reproductive rights (SRR)? Conversely, can the attention to individual human rights that is intrinsic to the SRHR agenda and its continuing concerns about equality, quality and accountability provide impetus for strengthening the health system? The paper argues that achieving equity on the UHC path will require a combination of system improvements and services that benefit all, together with special attention to those whose needs are great and who are likely to fall behind in the politics of choice and voice (i.e., progressive universalism paying particular attention to gender inequalities).
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Affiliation(s)
- Gita Sen
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Veloshnee Govender
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Fapohunda B, Orobaton N. Factors influencing the selection of delivery with no one present in Northern Nigeria: implications for policy and programs. Int J Womens Health 2014; 6:171-83. [PMID: 24516341 PMCID: PMC3916635 DOI: 10.2147/ijwh.s54628] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This paper examines the effects of demographic, socioeconomic, and women's autonomy factors on the utilization of delivery assistance in Sokoto State, Nigeria. Data were obtained from the Nigeria 2008 Demographic and Health Survey (DHS). Bivariate analysis and logistic regression procedures were conducted. The study revealed that delivery with no one present and with unskilled attendance accounted for roughly 95% of all births in Sokoto State. Mothers with existing high risk factors, including higher parity, were more likely to select unsafe/unskilled delivery practices than younger, lower-parity mothers. Evidenced by the high prevalence of delivery with traditional birth attendants, this study demonstrates that expectant mothers are willing to obtain care from a provider, and their odds of using accessible, affordable, skilled delivery is high, should such an option be presented. This conclusion is supported by the high correlation between a mother's socioeconomic status and the likelihood of using skilled attendance. To improve the access to, and increase the affordability of, skilled health attendants, we recommended two solutions: 1) the use of cash subsidies to augment women's incomes in order to reduce finance-related barriers in the use of formal health services, thus increasing demand; and 2) a structural improvement that will increase women's economic security by improving their access to higher education, income, and urban ideation.
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Affiliation(s)
| | - Nosakhare Orobaton
- International Division, John Snow Inc, Rosslyn, VA, USA ; Targeted States High Impact Project (TSHIP), Bauchi, Nigeria
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McGovern T. No risk, no gain: invest in women and girls by funding advocacy, organizing, litigation and work to shift culture. REPRODUCTIVE HEALTH MATTERS 2013; 21:86-102. [DOI: 10.1016/s0968-8080(13)42741-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Fapohunda BM, Orobaton NG. When women deliver with no one present in Nigeria: who, what, where and so what? PLoS One 2013; 8:e69569. [PMID: 23936047 PMCID: PMC3723888 DOI: 10.1371/journal.pone.0069569] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 06/13/2013] [Indexed: 11/19/2022] Open
Abstract
With the current maternal mortality ratio (MMR) of 630/100,000 live births, Nigeria ranks among the nations with the highest mortality rates in the world. The use of skilled assistants during delivery has been identified a key predictor in the reduction of mortality rates in the world over. Not only are Nigerian women predominantly using unskilled attendants, one in five births are delivered with No One Present (NOP). We assessed who, what, where and the so what of this practice using 2008 Nigeria DHS (NDHS) data. The study revealed that the prevalence of NOP is highest in the northern part of Nigeria with 94% of all observed cases. Socio-demographic factors, including, women's age at birth, birth order, being Muslim, and region of residence, were positively associated with NOP deliveries. Mother's education, higher wealth quintiles, urban residence, decision-making autonomy, and a supportive environment for women's social and economic security were inversely associated with NOP deliveries. Women's autonomy and social standing were critical to choosing to deliver with skilled attendance, which were further amplified by economic prosperity. Women's' economic wellbeing is entwined with their feelings of independence and freedom. Programs that seek to improve the autonomy of women and their strategic participation in sound health seeking decisions will, most likely, yield better results with improvements in women's education, income, jobs, and property ownership. As a short term measure, the use of conditional cash transfer, proven to work in several countries, including 18 in sub-Saharan Africa, is recommended. Its use has the potential to reduce household budget constraint by lowering cost-related barriers associated with women's ability to demand and use life-saving services. Given the preponderance of NOP in the Northern region, the study suggests that interventions to eradicate NOP deliveries must initially focus this region as priority.
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Affiliation(s)
- Bolaji M Fapohunda
- International Division, MEASURE Evaluation, John Snow, Incorporated, Rosslyn, Virginia, United States of America.
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Molina HF, Nakamura K, Kizuki M, Seino K. Reduction in inequality in antenatal-care use and persistence of inequality in skilled birth attendance in the Philippines from 1993 to 2008. BMJ Open 2013; 3:bmjopen-2012-002507. [PMID: 23794551 PMCID: PMC3686232 DOI: 10.1136/bmjopen-2012-002507] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess changes in the inequalities associated with maternal healthcare use according to economic status in the Philippines. DESIGN An analysis of four population-based data sets that were conducted between 1993 and 2008. SETTING Philippines. PARTICIPANTS Women aged 15-49 years who had a live-birth within 1 year in 1993 (n=1707), 1998 (n=1513), 2003 (n=1325) and 2008 (n=1209). OUTCOMES At least four visits of antenatal care, skilled birth attendance and delivery in a medical facility. RESULTS The adjusted OR for antenatal-care use when comparing the highest wealth-index quintile with the lowest quintile declined from 1993 to 2008: 3.43 (95% CI 2.22 to 5.28) to 2.87 (95% CI 1.31 to 6.29). On the other hand, the adjusted OR for the other two outcome indicators by the wealth index widened from 1993 to 2008: 9.92 (95% CI 5.98 to 16.43) to 15.53 (95% CI 6.90 to 34.94) for skilled birth attendance and 7.74 (95% CI 4.22 to 14.21) to 16.00 (95% CI 7.99 to 32.02) for delivery in a medical facility. The concentration indices for maternal health utilisation in 1993 and 2008 were 0.19 and 0.09 for antenatal care; 0.26 and 0.24 for skilled birth attendance and 0.41 and 0.35 for delivery in a medical facility. CONCLUSIONS Over a 16-year period, gradients in antenatal-care use decreased and the high level of inequalities in skilled birth attendance and delivery in a medical facility persisted. The results showed a disproportionate use of institutional care at birth among disadvantaged Filipino women.
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Affiliation(s)
- Honey Faith Molina
- International Health Section, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiko Nakamura
- International Health Section, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
| | - Masashi Kizuki
- Health Promotion Section, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
| | - Kaoruko Seino
- International Health Section, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
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Reid JNS, Bisanz JE, Monachese M, Burton JP, Reid G. The Rationale for Probiotics Improving Reproductive Health and Pregnancy Outcome. Am J Reprod Immunol 2013; 69:558-66. [DOI: 10.1111/aji.12086] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 01/07/2013] [Indexed: 12/19/2022] Open
Affiliation(s)
| | | | | | - Jeremy P. Burton
- Human Microbiology and Probiotics; Lawson Health Research Institute; London; ON; Canada
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Fonn S, Sundari Ravindran TK. The macroeconomic environment and sexual and reproductive health: a review of trends over the last 30 years. REPRODUCTIVE HEALTH MATTERS 2011; 19:11-25. [DOI: 10.1016/s0968-8080(11)38584-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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