1
|
Odwe G, Matanda DJ, Zulu T, Kizito S, Okoth O, Kangwana B. Women's empowerment and uptake of sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria during pregnancy: results from a cross-sectional baseline survey in the Lake endemic region, Kenya. Malar J 2023; 22:241. [PMID: 37612754 PMCID: PMC10463858 DOI: 10.1186/s12936-023-04679-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/17/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Malaria in pregnancy remains a major public health problem in endemic areas of the sub-Saharan African (SSA) region. However, there is limited understanding of the association between women's empowerment and the uptake of sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria during pregnancy (IPTp-SP) in Kenya. This study examines the association between women's empowerment indicators (decision-making power, control of assets, education, and employment status) and the uptake of three or more doses of IPTp-SP in the Lake endemic region of Kenya. METHODS The analysis utilized a dataset from a cross-sectional baseline survey of 3129 women aged 15-49 years in Kisumu and Migori Counties who had a live birth within the last 2 years preceding the study. Data were collected between June to August 2021. A descriptive analysis was conducted to show the distribution of respondents by key background characteristics, and bivariate and multivariate logistic regression to examine statistically significant associations between women's empowerment measures and the uptake of 3+ doses of IPTp-SP. RESULTS Among the 3129 women surveyed, 1978 (65.7%) received 3+ doses of IPTp-SP during their most recent pregnancy. Controlling for individual characteristics and the number of ANC visits, the odds of taking 3+ doses of IPTp-SP increased among women who had high decision-making autonomy (AOR = 2.33; CI = 1.81-3.01; P < 0.001); and tertiary level of educational attainment (AOR = 1.51; CI = 1.10-2.06). However, the association between control of assets and uptake of IPTp-SP was positive but not statistically significant. CONCLUSION Women's decision-making autonomy and educational attainment were positively associated with the uptake of IPTp-SP. As a result, maternal health interventions should focus on less empowered women, specifically those with less decision-making autonomy and no/low formal education, as they are less likely to achieve optimal uptake of IPTp-SP during pregnancy.
Collapse
Affiliation(s)
- George Odwe
- Population Council, Kenya, Avenue 5, 3rd Floor, Rose Avenue, P.O Box 17643-00500, Nairobi, Kenya.
| | - Dennis Juma Matanda
- Population Council, Kenya, Avenue 5, 3rd Floor, Rose Avenue, P.O Box 17643-00500, Nairobi, Kenya
| | - Tchaiwe Zulu
- Population Council, Kenya, Avenue 5, 3rd Floor, Rose Avenue, P.O Box 17643-00500, Nairobi, Kenya
| | - Stephen Kizito
- Population Council, Kenya, Avenue 5, 3rd Floor, Rose Avenue, P.O Box 17643-00500, Nairobi, Kenya
| | - Oscar Okoth
- Kisumu Medical and Education Trust (KMET), P. O Box 6805-40103, Kisumu, Kenya
| | - Beth Kangwana
- Population Council, Kenya, Avenue 5, 3rd Floor, Rose Avenue, P.O Box 17643-00500, Nairobi, Kenya
| |
Collapse
|
2
|
Sserwanja Q, Mukunya D, Musaba MW, Mutisya LM, Kamara K, Ziaei S. Women empowerment indices and utilization of health facilities during childbirth: evidence from the 2019 Sierra Leone demographic health survey. BMC Health Serv Res 2023; 23:109. [PMID: 36732806 PMCID: PMC9893537 DOI: 10.1186/s12913-023-09122-2] [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: 06/12/2022] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Women empowerment is recognized as a potential enabling factor to the utilization of health facilities during childbirth. However, the association between women empowerment and utilization of health facilities is poorly studied, especially in counties with high maternal mortality. Therefore, we investigated the association between women empowerment indices and the utilization of health facilities during childbirth in Sierra Leone. METHODS We analyzed secondary data from the 2019 Sierra Leone Demographic and Health Survey (SLDHS). We included 5,997 married women who had given birth in the five years before the survey, and had been sampled for the women empowerment questionnaire. The study employed the gender roles framework developed by the Harvard Institute for International Development in the selection and classification of women empowerment indices, which include influencing, resource and decision-making factors. We conducted logistic regression analyses using SPSS version 25.0 complex samples package to determine the association between women empowerment indices and utilization of health facilities. RESULTS The overall prevalence of health facility utilization during childbirth was 84.1% (5,042/5,997): 95% CI: 83.6 to 85.4. Among the influencer domain variables, women from the southern (aOR = 2.25, 95% CI: 1.34-3.78), northern (aOR = 1.69,95% CI: 1.01-2.82) and eastern regions (aOR = 3.71, 95% CI: 2.03-6.77) had higher odds of health facility utilization compared to women in the western region, while women in polygamous marriages (aOR = 0.82, 95% CI: 0.69-0.98) had lower odds of utilizing health facilities compared to their counterparts in monogamous marriages. Furthermore, women who had their first birth when they were less than 18 years, had higher odds of utilizing health facilities (aOR = 1.22, 95% CI: 1.02-1.45) compared to those who were 18 years and above. Among the resource domain variables, women with post-primary education (aOR = 1.58, 95% CI: 1.21-2.06) had higher odds of utilizing health facilities compared to their counterparts with no education and women who belonged to the richest wealth quintile (aOR = 2.42, 95% CI: 1.31-4.46) had higher odds of utilizing health facilities compared to their counterparts belonging in the poorest quintile. None of the variables in the decision making domain was significantly associated with health facility utilization. CONCLUSION These findings emphasize that, successful implementation of health facility utilization interventions should prioritize women empowerment with more pragmatic efforts. Policies and programme should aim at all women with more focus on those having lower education (primary and below), belonging to the poorest wealth quintile, give birth before reaching18 years and in polygamous marriages.
Collapse
Affiliation(s)
- Quraish Sserwanja
- Programmes Department, GOAL Global, Arkaweet Block 65 House No. 227, Khartoum, Sudan
| | - David Mukunya
- grid.448602.c0000 0004 0367 1045Department of Public Health, Busitema University, Mbale, Uganda ,Department of Research, Nikao Medical Center, Kampala, Uganda
| | - Milton W. Musaba
- Department of Obstetrics and Gynaecology, Mbale Regional Referral and Teaching Hospital, Mbale, Uganda ,grid.448602.c0000 0004 0367 1045Department of Obstetrics and Gynaecology, Busitema University, Tororo, Uganda
| | - Linet M. Mutisya
- Maternal and Child Health Project, Swedish Organization for Global Health, Mayuge, Uganda
| | - Kassim Kamara
- grid.463455.50000 0004 1799 20697National Disease Surveillance Programme, Ministry of Health and Sanitation, Free Town, Sierra Leone
| | - Shirin Ziaei
- grid.8993.b0000 0004 1936 9457Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| |
Collapse
|
3
|
Psychosocial influences on pregnancy and childbirth behaviours in north-western Nigeria: a cross-sectional analysis. J Biosoc Sci 2023; 55:131-149. [PMID: 35129108 DOI: 10.1017/s0021932021000729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Antenatal care (ANC) and facility delivery are essential maternal health services, but uptake remains low in north-western Nigeria. This study aimed to assess the psychosocial influences on pregnancy and childbirth behaviours in Nigeria. Data were from a cross-sectional population-based survey of randomly sampled women with a child under 2 years conducted in Kebbi, Sokoto and Zamfara states of north-western Nigeria in September 2019. Women were asked about their maternal health behaviours during their last pregnancy. Psychosocial metrics were developed using the Ideation Model of Strategic Communication and Behaviour Change. Predicted probabilities for visiting ANC four or more times (ANC4+) and giving birth in a facility were derived using mixed-effects logistic regression models adjusted for ideational and socio-demographic variables. Among the 3039 sample women, 23.6% (95% CI: 18.0-30.3%) attended ANC4+ times and 15.5% (95% CI: 11.8-20.1%) gave birth in a facility. Among women who did not attend ANC4+ times or have a facility-based delivery during their last pregnancy, the most commonly cited reasons for non-use were lack of perceived need (42% and 67%, respectively) and spousal opposition (25% and 27%, respectively). Women who knew any ANC benefit or the recommended number of ANC visits were 3.2 and 2.1 times more likely to attend ANC4+ times, respectively. Women who held positive views about health facilities for childbirth had 1.2 and 2.6 times higher likelihood of attending ANC4+ times and having a facility delivery, respectively, while women who believed ANC was only for sickness or pregnancy complications had a 17% lower likelihood of attending ANC4+ times. Self-efficacy and supportive spousal influence were also significantly associated with both outcomes. To improve pregnancy and childbirth practices in north-western Nigeria, Social and Behavioural Change programmes could address a range of psychosocial factors across cognitive, emotional and social domains which have been found in this study to be significantly associated with pregnancy and childbirth behaviours: raising knowledge and dispelling myths, building women's confidence to access services, engaging spousal support in decision-making and improving perceived (and actual) maternal health services quality.
Collapse
|
4
|
Zhang X, Anser MK, Ahuru RR, Zhang Z, Peng MYP, Osabohien R, Mirza M. Do Predictors of Health Facility Delivery Among Reproductive-Age Women Differ by Health Insurance Enrollment? A Multi-Level Analysis of Nigeria's Data. Front Public Health 2022; 10:797272. [PMID: 35493387 PMCID: PMC9047955 DOI: 10.3389/fpubh.2022.797272] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
This study aims to compare determinants of health facility delivery for women under a health insurance scheme and those not under a health insurance scheme. Secondary data drawn from the National Demographic and Health Survey was used for the analysis. The characteristics of the women were presented with simple proportions. Binary multilevel logistic regression was used to examine the determinants of health facilities for women who enrolled in health insurance and those who did not. All statistical analyses were set at 5% level of significant level (p = 0.24). The result showed that 2.1% of the women were under a health insurance scheme. Disparity exists in health insurance ownership as a higher proportion of those enrolled in health insurance were those with higher education attainment, in urban parts of the country, and those situated on higher wealth quintiles. There is a significant difference between those with and those without health insurance. It implies that a higher proportion of women who enrolled in health insurance delivered in health facility delivery compared to those who do not. The unique determinants of health facility delivery for women under health insurance were parity and birth order, while unique determinants of health facility delivery for women not enrolled in health schemes were employment status, marriage type, and geopolitical zones. Uniform predictors of health facility delivery for both groups of women were maternal education, household wealth quintiles, autonomy on healthcare, number of antenatal contacts, residential status, community-level poverty, community-level media use, and community-level literacy. Intervention programs designed to improve health facility delivery should expand educational opportunities for women, improve household socioeconomic conditions, target rural women, and encourage women to undertake a minimum of four antenatal contacts.
Collapse
Affiliation(s)
- Xiaomei Zhang
- School of Humanities, Arts and Education, Shandong Xiehe University, Jinan, China
| | - Muhammad Khalid Anser
- School of Public Administration, Xi'an University of Architecture and Technology, Xi'an, China
| | - Rolle Remi Ahuru
- Department of Economics, Faculty of Social Sciences, University of Benin, Benin City, Nigeria
| | - Zizai Zhang
- Hangzhou Preschool Teachers College, Zhejiang Normal University, Hangzhou, China
| | | | - Romanus Osabohien
- Department of Economics and Development Studies, Covenant University, Ota, Nigeria
- Centre for Economics and Development Studies, Covenant University, Ota, Nigeria
- Honorary Research Fellow, ILMA University, Karachi, Pakistan
| | - Mumal Mirza
- Department of Media Science, ILMA University, Karachi, Pakistan
| |
Collapse
|
5
|
Aikpitanyi J, Okonofua F, Ntoimo L, Tubeuf S. Locus of Control and Self-Esteem as Predictors of Maternal and Child Healthcare Services Utilization in Nigeria. FRONTIERS IN HEALTH SERVICES 2022; 2:847721. [PMID: 36925792 PMCID: PMC10012786 DOI: 10.3389/frhs.2022.847721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/07/2022] [Indexed: 11/13/2022]
Abstract
This study investigated the influence of locus of control and self-esteem on the utilization of maternal and child healthcare services in Nigeria. Specifically, it explored the differences in utilization of antenatal care, skilled birth care, postnatal care, and child vaccination by women having internal and external locus of control and women having high and low self-esteem. It also examined the association between utilization of maternal and child healthcare on other sociodemographic characteristics. We collected information on non-cognitive traits of 1,411 randomly selected women along with information on utilization of various indicators of maternal and child healthcare services. We estimated logistic regression models for various components of maternal and child healthcare services utilization and found that women's internal locus of control was a significant predictor of utilization of antenatal care, skilled birth care and completion of child vaccination. We also found that having a high self-esteem was a significant predictor of utilization of antenatal care, postnatal care and completion of child vaccination after adjusting for other control variables. By improving our understanding of non-cognitive traits as possible barriers to maternal and child healthcare utilization, our findings offer important insights for enhancing participants' engagement in intervention programs that are initiated to improve maternal and child health outcomes in lower-middle-income countries.
Collapse
Affiliation(s)
- Josephine Aikpitanyi
- Institute of Health Research and Society (IRSS), Université catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium.,Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin, Nigeria
| | - Friday Okonofua
- Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin, Nigeria
| | - Lorretta Ntoimo
- Department of Demography and Statistics, Federal University Oye Ekiti, Ekiti, Nigeria
| | - Sandy Tubeuf
- Institute of Health Research and Society (IRSS), Université catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium.,Institute of Economic and Social Research (IRES), Université catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
| |
Collapse
|
6
|
Chai Y, Ríos-Salas V, Stek P, Heymann J. Does Enhancing Paid Maternity Leave Policy Help Promote Gender Equality? Evidence from 31 Low- and Middle-Income Countries. GENDER ISSUES 2021; 39:335-367. [PMID: 35875727 PMCID: PMC9300538 DOI: 10.1007/s12147-021-09293-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 06/15/2023]
Abstract
Globally, women continue to have less economic decision-making power and face gender-unequal norms at work. Little is known about the impact of national public policies on norms surrounding equality. We examined the impact of extending paid maternity leave policy on decision making in the household and gender norms in the workplace, specifically whether women have sole or joint decision-making power with respect to large household purchases and whether women are perceived as having an equal right to jobs when jobs are scarce. We used difference-in-differences models to analyze the impact of increasing paid maternity leave on outcomes measured in the Demographic Health Surveys and World Values Surveys collected in 31 low- and middle-income countries. A one-month increase in the legislated duration of paid maternity leave increased the odds that women and their partners/spouses reported that women had more decision-making power by 40% (95% CI 1.14, 1.70) and 66% (95% CI 1.36, 2.03), respectively. A one-month increase in the legislated duration of paid maternity leave was associated with 41.5 percentage-point increase in the prevalence of individuals disagreeing with the statement that "when jobs are scarce, men should have more right to a job than women." More generous maternity leave increases gender equality in economic decision making in the household and improves gender norms related to work. Future studies should examine the impact of paternity leave and non-discrimination policy, as well as other large-scale policies aiming to improve gender equality at work and at home.
Collapse
Affiliation(s)
- Yan Chai
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, 621 Charles E. Young Drive South, Los Angeles, CA 90095 USA
| | - Vanessa Ríos-Salas
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, 621 Charles E. Young Drive South, Los Angeles, CA 90095 USA
| | - Pam Stek
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, 621 Charles E. Young Drive South, Los Angeles, CA 90095 USA
| | - Jody Heymann
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, 621 Charles E. Young Drive South, Los Angeles, CA 90095 USA
| |
Collapse
|
7
|
Sui Y, Ahuru RR, Huang K, Anser MK, Osabohien R. Household Socioeconomic Status and Antenatal Care Utilization Among Women in the Reproductive-Age. Front Public Health 2021; 9:724337. [PMID: 34589464 PMCID: PMC8475754 DOI: 10.3389/fpubh.2021.724337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/29/2021] [Indexed: 12/04/2022] Open
Abstract
The study examined the effect of household socioeconomic status and other socio-demographic characteristics on antenatal care (ANC) utilization among 819 women within the reproductive ages across eight rural communities in Delta State, Southern part of Nigeria. Characteristics of the women were described using simple proportion and frequency. The chi-square test was used to examine factors that were significantly associated with a minimum of four (≥4) and eight (≥8) antenatal care contacts, which were respectively in line with the focused ANC and WHO's new guideline. The multivariable logistic regression was used to examine the determinants of a minimum of four and eight ANC. Statistical analyses were set at 5%. The results showed that 31.4% (257/819) and 2.2% (18/819) of mothers, respectively, made ≥ 4 and ≥ 8 ANC contacts in the course of their last pregnancies. According to the results, the odds for reporting 4≥ and ≥ 8 ANC improved with both wealth and educational attainment. Distance to the health center and cost are barriers to maternal care utilization and they reduce the odds for undertaking ≥ 4 and ≥8 ANC contacts. Women on higher media exposure were more likely to undertake ≥ 4 and ≥8 ANC contacts, and those on the highest media exposure were more likely to undertake ≥8 ANC contacts. Financing maternal care through health insurance and free maternal care significantly improves the odds to undertake ≥ 4 and ≥ 8 ANC contacts. Intervention programs should be designed to improve access to maternal care services and should expand education opportunities for mothers, improve household socioeconomic conditions, and encourage enrolment in health insurance and free maternal care in the study area.
Collapse
Affiliation(s)
- Yubing Sui
- School of Finance and Economics, Shenzhen Institute of Information Technology, Shenzhen, China
| | - Rolle Remi Ahuru
- Department of Economics, Faculty of Social Sciences, University of Benin, Benin City, Nigeria
| | - Kaishan Huang
- Center for Innovation and Entrepreneurship Education, Shenzhen University, Shenzhen, China
| | - Muhammad Khalid Anser
- School of Public Administration, Xi'an University of Architecture and Technology, Xi'an, China
| | - Romanus Osabohien
- Department of Economics and Development Studies, Covenant University, Ota, Nigeria
| |
Collapse
|