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Yalew M, Molla A, Bogale GG, Birhane T, Arefaynie M, Damtie Y, Kefale B, Adane B. Spatial distribution and associated factors of dropout from health facility delivery after antenatal booking in Ethiopia: a multi-level analysis. BMC Womens Health 2023; 23:79. [PMID: 36823622 PMCID: PMC9948476 DOI: 10.1186/s12905-023-02229-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 02/14/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Nowadays, retaining women in the continuum of care throughout the lifecycle: adolescence, pregnancy, childbirth, postpartum, and childhood in reproductive health is one of the recent global concerns. Most of the previous studies focused on individual-level factors and used classical logistic regression. Furthermore, it doesn't take into account its distribution. Therefore, this study aimed to assess spatial distribution, and associated factors of dropout from health facility delivery after antenatal booking among postpartum women in Ethiopia. METHOD Cross-sectional study by secondary analysis of the Ethiopian Mini Demographic and Health Survey (EMDHS) 2019 dataset was conducted among postpartum women. A total of 2882 women who gave birth 5 years prior to the survey were included. Sampling weight was applied and the analysis was done using STATA version 16. Aeronautical Reconnaissance Coverage Geographic Information System (ArcGIS) 10.8 software was used to map the cluster and attribute of dropout from health facility delivery and Global and local Moran's Index methods were used to assess the extent of clustering. Multi-level (two-level) logistic regression analysis was used and variables with a P value less than 0.5 were considered statistical significance. Adjusted odds ratio AOR) with a 95% confidence interval was used to show the strength and direction of the association respectively. RESULTS Dropout from health facility delivery after ANC (Antenatal Care) booking in Ethiopia was 35.42%, 95% CI (33.70, 37.19), and it spatially clustered (Moran's index = 0.51, P value < 0.001). From individual-level variables: women who were primary educated [AOR = 0.70, 95% CI (0.49, 0.98)], secondary educated [AOR = 0.38, 95% CI (0.19, 0.73)], lived in the middle [AOR = 0.54, 95% CI (0.29, 0.98)], richer wealth [AOR = 0.37, 95% CI (0.18, 0.78)], richest wealth [AOR = 0.21, 95% CI (0.06, 0.74)], being counseled about pregnancy and childbirth complications [AOR = 0.52, 95% CI (0.34, 0.80)] and women who had four and above ANC visit [AOR = 0.52, 95% CI (0.38, 0.71)] were negatively associated with dropout. Whereas, second birth order [AOR = 2.62, 95% CI (1.40, 4.89)], 3-4th birth order [AOR = 4.92, 95% CI (2.82, 8.60)], above 4th birth order [AOR = 4.77, 95% CI (2.16, 10.53))] were positively associated with dropout. From community-level variables: mothers who lived in Afar [AOR = 2.61, 95% CI (1.08, 6.32)] and Oromia [AOR = 2.63, 95% CI (1.15, 6.02)] were positively associated with dropout from health facility delivery after ANC booking. CONCLUSIONS Dropout from health facility delivery after ANC booking was high as the government's effort and its spatial distribution in Ethiopia was clustered. Increased educational status of the mother, having four or more ANC visits, counseled about pregnancy and childbirth complications, and higher household wealth were negatively associated and higher birth order, and living in Oromia and Afar region were positively associated with dropout in Ethiopia. Strengthening women's education, encouraging women to complete ANC visits, being counseled them on pregnancy and childbirth complications, and improving family wealth status will be the recalled intervention areas of the government.
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Affiliation(s)
- Melaku Yalew
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia.
| | - Asiressie Molla
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Getahun Gebre Bogale
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tesfaye Birhane
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mastewal Arefaynie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yitayish Damtie
- Department of Reproductive Health, School of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Bereket Kefale
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bezawit Adane
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
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Lin KY, Tsai YJ, Yang JF, Wu MH. Factors associated with utilization of physical therapy services during pregnancy and after childbirth. Heliyon 2023; 9:e13247. [PMID: 36798765 PMCID: PMC9925962 DOI: 10.1016/j.heliyon.2023.e13247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/03/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
Objective To explore demographic and clinical factors associated with utilization of antepartum/postpartum physical therapy. Methods This is a secondary analysis of a cross-sectional survey of 298 women who were receiving or had received obstetric care at a medical center in southern Taiwan. Data were collected between May 2021 and May 2022 using an online questionnaire, which included demographic, medical, and obstetric details, the symptom severity questionnaires, management strategies, and experience and perception about physical therapy. Descriptive statistics, independent t-test, chi-square analysis and multivariate logistic regression model were used to analyze data. Results Among 298 respondents, 190 (63.8%) were pregnant and 108 (36.2%) were postpartum. Thirteen percent of pregnant participants and 27% of postpartum participants had received physical therapy during and/or after childbirth. Multivariate analyses showed that being postpartum, having an associate degree and below, and experiencing depressive symptoms were significantly associated with an increased utilization of physical therapy (postpartum: OR = 3.039, 95% CI = 1.530, 6.035; associate degree and below: OR = 2.521, 95% CI = 1.007, 6.316; depressive symptoms: OR = 3.606, 95% CI = 1.067, 12.185). The odds of utilizing physical therapy decreased with age (OR = 0.935, 95% CI = 0.874, 1.000). Conclusions Individual factors, such as age, education level, pregnancy status, and experience of depressive symptoms, have a significant association with utilization of antepartum/postpartum physical therapy and should be considered when developing obstetric care pathways to optimize clinical and healthcare utilization outcomes.
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Affiliation(s)
- Kuan-Yin Lin
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Corresponding author. Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Yi-Ju Tsai
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jeng-Feng Yang
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Physical Therapy Center, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Meng-Hsing Wu
- Department of Obstetrics and Gynecology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Woldegiorgis MA, Meyer D, Hiller JE, Mekonnen W, Bhowmik J. Inter-relationships among key reproductive health indicators in sub-Saharan Africa focusing on the central role of maternal literacy. Int Health 2022; 14:421-433. [PMID: 32043526 PMCID: PMC9248058 DOI: 10.1093/inthealth/ihz117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/21/2019] [Accepted: 11/08/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Indicators of reproductive health (RH) are expected to be both inter-related and associated with key social determinants. As the provision of RH services is usually integrated, the effort to improve one RH component should influence the other components. However, there is a lack of evidence-based models demonstrating the inter-relationships. The purpose of this study was to examine the inter-relationships among key RH indicators and their relationship with women's literacy in sub-Saharan Africa (SSA). METHODS Data were sourced from the most recent demographic and health survey conducted between 2010 and 2016 in 391 provinces of 29 SSA countries. We examined seven RH indicators along with women's literacy. The unit of analysis was at the provincial level. Structural equation modelling was used to examine the strength of relationships among these indicators and with women's literacy, using the total standardized effect sizes. Significance tests and 95% confidence intervals (CIs) for these effects were calculated using a bias-corrected bootstrap method. RESULTS RH indicators are strongly interrelated and are associated with women's literacy. The strongest relationship is observed between women's literacy rate and the contraception prevalence rate, with a total standardized effect size of 0.79 (95% CI 0.74-0.83). The model of inter-relationships developed in this study may guide the design, implementation and evaluation of RH policies and programmes. CONCLUSIONS The key challenge in reducing fertility in SSA is to reduce people fertility desire. This could mainly be addressed by enhancing integrated approaches especially between the education and health sectors.
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Affiliation(s)
- Mulu Abraha Woldegiorgis
- Burnet Institute, Public Health, Melbourne, Australia
- Swinburne University of Technology, School of Health Sciences, Melbourne, Australia
| | - Denny Meyer
- Swinburne University of Technology, School of Health Sciences, Melbourne, Australia
| | - Janet E Hiller
- Swinburne University of Technology, School of Health Sciences, Melbourne, Australia
- University of Adelaide, School of Public Health, Adelaide, Australia
| | | | - Jahar Bhowmik
- Swinburne University of Technology, School of Health Sciences, Melbourne, Australia
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Kumar P, Dhillon P. Structural equation modeling on the relationship between maternal characteristics and pregnancy complications: A study based on National Family Health Survey. J Obstet Gynaecol Res 2020; 47:592-605. [PMID: 33191654 DOI: 10.1111/jog.14566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/12/2020] [Accepted: 11/02/2020] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to understand the complex relationship between maternal complications and women's characteristics in India. METHODS The present study builds structural equation modeling (SEM) using the data from the National Family Health Survey round 4 (2015-16) and includes 190, 898 women who had given their last birth during 5 years preceding the survey. Based on eight questions related to maternal complications, the SEM constructed two latent variables - complications during pregnancy (PREGCOMP) and delivery (DELCOMP). RESULTS Result shows that prolonged labor was highly prevalent (42%) among women, followed by vaginal bleeding (34%) and swelling in legs, body or face (32%). Women from affluent households (β = -0.02 for each-middle, richer and richest quantile), with higher education (β = -0.02), timing when they received first ANC (β = -0.003) and women who received full ANC (β = -0.01) had a lower risk of PREGCOMP. However, consanguineous marriage (β = 0.01) was positively related to PREGCOMP. Further, women with PREGCOMP (β = 0.20), rural residents (β = 0.02), having exposure to mass media (β = 0.01), and who had facility delivery (β = 0.04) were at high risk of DELCOMP. Women with pregnancy complications are more likely to have delivery complications. [Correction added on 27 November, after first online publication: The statement "who received full antenatal care (ANC) (β = -0.05)" has been removed.] CONCLUSION: Socioeconomic and demographic factors significantly affect both the latent variables. This study concludes that the use of intensive healthcare services reduces health complications. The paper recommends early visits and full ANC checkups to reduce pregnancy complications.
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Affiliation(s)
- Pradeep Kumar
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, India
| | - Preeti Dhillon
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, India
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Home or Healthcare Facility: Influence of Antenatal Health Service on the Decision on the Place of Birth in Indonesia. CASPIAN JOURNAL OF HEALTH RESEARCH 2020. [DOI: 10.52547/cjhr.5.3.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Samba M, Attia-Konan AR, Sangaré AD, Youan GJ, Kouadio LP, Bakayoko-Ly R. Factors associated with the use of maternal health services by mothers in a post-conflict area of western Côte d'Ivoire in 2016. BMC Health Serv Res 2020; 20:136. [PMID: 32087713 PMCID: PMC7036223 DOI: 10.1186/s12913-020-4976-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 02/11/2020] [Indexed: 11/18/2022] Open
Abstract
Background In Côte d’Ivoire, maternal health service utilization indicators remain low despite improvements in health coverage and the availability of free health care for pregnant women. The objective of the study was to identify the determinants associated with the use of maternal health services in the department of Bloléquin, in western Côte d’Ivoire. Methods We conducted a cross-sectional study with an analytical focus. The study sample size was 400 women. Study participants were selected through a two-stage cluster survey. The data were collected using a standardized questionnaire whose items concerned socio-demographic data, the different uses of maternal health services, namely childbirth assisted by a health professional, use of family planning, prenatal consultation and postnatal consultation. Logistic regression was used to investigate factors associated with the use of maternal health services. The significance of the statistical tests was set at 5%. The odds ratios and 95% confidence intervals were calculated and interpreted. Results The results showed that women made less use of family planning services (OR = 0.4), prenatal consultation (OR = 0.2) and assisted childbirth (OR = 0.2) when they provided the funding for care themselves. Women with monthly incomes above $26.8 used family planning services 4 times more than those with lower incomes. Married women used prenatal consultations 3 times more often than unmarried women (CI95% = 1.4–7.3). Desiring pregnancy increased the use of post-natal consultations by 3 times (CI95% = 1.5–6.1). Conclusion Improving the use of maternal health services in western Côte d’Ivoire requires taking into account women’s socio-cultural and economic challenges. In initiatives related to the financial empowerment of women, efforts must be made at the level of emotional considerations related to pregnancy.
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Affiliation(s)
- Mamadou Samba
- Public Health and Medicinal Plants Laboratory, UFR Odonto-Stomatology University Félix Houphouet-Boigny, Abidjan, Côte d'Ivoire
| | - Akissi Régine Attia-Konan
- Department of Public Health, Hydrology and Toxicology UFR of Pharmaceutical and Biological Sciences / Unvisersity Félix Houphouet-Boigny, Abidjan, Côte d'Ivoire.
| | - Abou Dramane Sangaré
- Public Health and Medicinal Plants Laboratory, UFR Odonto-Stomatology University Félix Houphouet-Boigny, Abidjan, Côte d'Ivoire
| | | | - Luc Philippe Kouadio
- Department of Public Health, Hydrology and Toxicology UFR of Pharmaceutical and Biological Sciences / Unvisersity Félix Houphouet-Boigny, Abidjan, Côte d'Ivoire
| | - Ramata Bakayoko-Ly
- Public Health and Medicinal Plants Laboratory, UFR Odonto-Stomatology University Félix Houphouet-Boigny, Abidjan, Côte d'Ivoire
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Benova L, Owolabi O, Radovich E, Wong KLM, Macleod D, Langlois EV, Campbell OMR. Provision of postpartum care to women giving birth in health facilities in sub-Saharan Africa: A cross-sectional study using Demographic and Health Survey data from 33 countries. PLoS Med 2019; 16:e1002943. [PMID: 31644531 PMCID: PMC6808422 DOI: 10.1371/journal.pmed.1002943] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 09/16/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Postpartum care has the potential to avert a substantial proportion of maternal and perinatal mortality and morbidity. There is a crucial gap in understanding the quality of postpartum care for women giving birth in health facilities in low- and middle-income settings. This is particularly the case in sub-Saharan Africa (SSA), where the levels of maternal and neonatal mortality are highest globally despite rapid increases in facility-based childbirth. This study estimated the percentage of women receiving a postpartum health check following childbirth in a health facility in SSA and examined the determinants of receiving such check. METHODS AND FINDINGS We used the most recent Demographic and Health Survey (DHS) conducted in 33 SSA countries between 2000-2016. We estimated the percentage of women receiving a postpartum check by a health professional while in the childbirth facility and the associated 95% confidence interval (CI) for each country. We analyzed determinants of receiving such checks using logistic regression of the pooled data. The analysis sample included 137,218 women whose most recent live birth in the 5- year period before the survey took place in a health facility. Of this pooled sample, 65.7% of women were under 30 years of age, 85.9% were currently married, and 57% resided in rural areas. Across countries, the median percentage of women who reported receiving a check was 71.7%, ranging from 26.6% in Eswatini (Swaziland) to 94.4% in Burkina Faso. The most fully adjusted model showed that factors from all four conceptual categories (obstetric/neonatal risk factors, care environment, and women's sociodemographic and child-related characteristics) were significant determinants of receiving a check. Women with a cesarean section had a significantly higher adjusted odds ratio (aOR) of 1.88 (95% CI 1.72-2.05, p < 0.001) of receiving a check. Women giving birth in lower-level public facilities had lower odds of receiving a check (aOR 0.94, 95% CI 0.90-0.98, p = 0.002) compared to those in public hospitals, as did women attended by a nurse/midwife (compared to doctor/nonphysician clinician) (aOR 0.74, 95% CI 0.69-0.78, p < 0.001). This study was limited by the accuracy of the respondent's recall of the provider, timing, and receipt of postpartum checks. The outcome of interest was measured using three slightly different question sets across the 33 included countries. CONCLUSIONS The suboptimal levels of postpartum checks in health facilities in many of the included SSA countries partially reflect the lack of importance given to postpartum care in the global discourse on essential interventions and quality improvement in maternal health. Addressing disparities in access to both facility-based childbirth and good-quality postpartum care in SSA is critical to addressing stalling declines in maternal mortality and morbidity.
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Affiliation(s)
- Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Onikepe Owolabi
- Guttmacher Institute, New York City, New York, United States of America
| | - Emma Radovich
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kerry L. M. Wong
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Macleod
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Etienne V. Langlois
- Alliance for Health Policy and Systems Research, Science Division, World Health Organization, Geneva, Switzerland
| | - Oona M. R. Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Quality of maternity care and its determinants along the continuum in Kenya: A structural equation modeling analysis. PLoS One 2017; 12:e0177756. [PMID: 28520771 PMCID: PMC5433759 DOI: 10.1371/journal.pone.0177756] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 05/03/2017] [Indexed: 11/29/2022] Open
Abstract
Background Improving access to delivery services does not guarantee access to quality obstetric care and better survival, and therefore, concerns for quality of maternal and newborn care in low- and middle-income countries have been raised. Our study explored characteristics associated with the quality of initial assessment, intrapartum, and immediate postpartum and newborn care, and further assessed the relationships along the continuum of care. Methods The 2010 Service Provision Assessment data of Kenya for 627 routine deliveries of women aged 15–49 were used. Quality of care measures were assessed using recently validated quality of care measures during initial assessment, intrapartum, and postpartum periods. Data were analyzed with negative binomial regression and structural equation modeling technique. Results The negative binomial regression results identified a number of determinants of quality, such as the level of health facilities, managing authority, presence of delivery fee, central electricity supply and clinical guideline for maternal and neonatal care. Our structural equation modeling (SEM) further demonstrated that facility characteristics were important determinants of quality for initial assessment and postpartum care, while characteristics at the provider level became more important in shaping the quality of intrapartum care. Furthermore we also noted that quality of initial assessment had a positive association with quality of intrapartum care (β = 0.71, p < 0.001), which in turn was positively associated with the quality of newborn and immediate postpartum care (β = 1.29, p = 0.004). Conclusions A continued focus on quality of care along the continuum of maternity care is important not only to mothers but also their newborns. Policymakers should therefore ensure that required resources, as well as adequate supervision and emphasis on the quality of obstetric care, are available.
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