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Li Q, Kanduma E, Ramiro I, Xu DR, Cuco RMM, Chaquisse E, Yang Y, Wang X, Pan J. Spatial Access to Continuous Maternal and Perinatal Health Care Services in Low-Resource Settings: Cross-Sectional Study. JMIR Public Health Surveill 2024; 10:e49367. [PMID: 39024564 PMCID: PMC11294765 DOI: 10.2196/49367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/26/2023] [Accepted: 05/07/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Maternal and perinatal health are fundamental to human development. However, in low-resource settings such as sub-Saharan Africa (SSA), significant challenges persist in reducing maternal, newborn, and child mortality. To achieve the targets of the sustainable development goal 3 (SDG3) and universal health coverage (UHC), improving access to continuous maternal and perinatal health care services (CMPHS) has been addressed as a critical strategy. OBJECTIVE This study aims to provide a widely applicable procedure to illuminate the current challenges in ensuring access to CMPHS for women of reproductive age. The findings are intended to inform targeted recommendations for prioritizing resource allocation and policy making in low-resource settings. METHODS In accordance with the World Health Organization guidelines and existing literature, and taking into account the local context of CMPHS delivery to women of reproductive age in Mozambique, we first proposed the identification of CMPHS as the continuum of 3 independent service packages, namely antenatal care (ANC), institutional delivery (ID), and postnatal care (PNC). Then, we used the nearest-neighbor method (NNM) to assess spatial access to each of the 3 service packages. Lastly, we carried out an overlap analysis to identify 8 types of resource-shortage zones. RESULTS The median shortest travel times for women of reproductive age to access ANC, ID, and PNC were 2.38 (IQR 1.38-3.89) hours, 3.69 (IQR 1.87-5.82) hours, and 4.16 (IQR 2.48-6.67) hours, respectively. Spatial barriers for women of reproductive age accessing ANC, ID, and PNC demonstrated large variations both among and within regions. Maputo City showed the shortest travel time and the best equity within the regions (0.46, IQR 0.26-0.69 hours; 0.74, IQR 0.47-1.04 hours; and 1.34, IQR 0.83-1.85 hours, respectively), while the provinces of Niassa (4.07, IQR 2.41-6.63 hours; 18.20, IQR 11.67-24.65 hours; and 7.69, IQR 4.74-13.05 hours, respectively) and Inhambane (2.69, IQR 1.49-3.91 hours; 4.43, IQR 2.37-7.16 hours; and 10.76, IQR 7.73-13.66 hours, respectively) lagged behind significantly in both aspects. In general, more than 51% of the women of reproductive age, residing in 83.25% of Mozambique's land area, were unable to access any service package of CMPHS in time (within 2 hours), while only about 21%, living in 2.69% of Mozambique's land area, including Maputo, could access timely CMPHS. CONCLUSIONS The spatial accessibility and equity of CMPHS in Mozambique present significant challenges in achieving SDG3 and UHC, especially in the Inhambane and Niassa regions. For Inhambane, policy makers should prioritize the implementation of a decentralization allocation strategy to increase coverage and equity through upgrading existing health care facilities. For Niassa, the cultivation of well-trained midwives who can provide door-to-door ANC and PNC at home should be prioritized, with an emphasis on strengthening communities' engagement. The proposed 2-step procedure should be implemented in other low-resource settings to promote the achievement of SDG3.
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Affiliation(s)
- Qin Li
- HEOA Group, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, China
- Institute for Healthy Cities, West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
| | - Elsa Kanduma
- Comité para a Saúde de Moçambique, Maputo City, Mozambique
| | - Isaías Ramiro
- Comité para a Saúde de Moçambique, Maputo City, Mozambique
| | - Dong Roman Xu
- Acacia Lab for Implementation Science, Center for World Health Organization Studies, School of Health Management, Southern Medical University, Guangzhou, China
- SMU Institute for Global Health, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Rosa Marlene Manjate Cuco
- Mozambique Ministry of Health and Faculty of Medicine, Eduardo Mondlane University, Maputo City, Mozambique
| | - Eusebio Chaquisse
- Mozambique Ministry of Health and Faculty of Medicine, Eduardo Mondlane University, Maputo City, Mozambique
| | - Yili Yang
- HEOA Group, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, China
- Institute for Healthy Cities, West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
| | - Xiuli Wang
- HEOA Group, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, China
- Institute for Healthy Cities, West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
| | - Jay Pan
- HEOA Group, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, China
- China Center for South Asian Studies, Sichuan University, Chengdu, China
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Daca CSL, Schumann B, Arnaldo C, San Sebastian M. Wealth inequalities in reproductive and child health preventive care in Mozambique: a decomposition analysis. Glob Health Action 2022; 15:2040150. [PMID: 35290171 PMCID: PMC8928807 DOI: 10.1080/16549716.2022.2040150] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Assessing the gap between rich and poor is important to monitor inequalities in health. Identifying the contribution to that gap can help policymakers to develop interventions towards decreasing that difference. Objective To quantify the wealth inequalities in health preventive measures (bed net use, vaccination, and contraceptive use) to determine the demographic and socioeconomic contribution factors to that inequality using a decomposition analysis. Methods Data from the 2015 Immunisation, Malaria and AIDs Indicators Survey were used. The total sample included 6946 women aged 15–49 years. Outcomes were use of insecticide-treated nets (ITN), child vaccination, and modern contraception use. Wealth Index was the exposure variable and age, marital status, place of residence, region, education, occupation, and household wealth index were the explanatory variables. Wealth inequalities were assessed using concentration indexes (Cindex). Wagstaff-decomposition analysis was conducted to assess the determinants of the wealth inequality. Results The Cindex was −0.081 for non-ITN, −0.189 for lack of vaccination coverage and −0.284 for non-contraceptive use, indicating a pro-poor inequality. The results revealed that 88.41% of wealth gap for ITN was explained by socioeconomic factors, with education and wealth playing the largest roles. Lack of full vaccination, socioeconomic factors made the largest contribution, through the wealth variable, whereas geographic factors came next. Finally, the lack of contraceptive use, socioeconomic factors were the main explanatory factors, but to a lesser degree than the other two outcomes, with wealth and education contributing most to explaining the gap. Conclusion There was a pro-poor inequality in reproductive and child preventive measures in Mozambique. The greater part of this inequality could be attributed to wealth, education, and residence in rural areas. Resources should be channeled into poor and non-educated rural communities to tackle these persistent inequities in preventive care.
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Affiliation(s)
- Chanvo S L Daca
- Department of Cooperation, Ministry of Health, Directorate of Planning and Cooperation, Maputo, Mozambique.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Barbara Schumann
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Factors Associated with Underutilization of Maternity Health Care Cascade in Mozambique: Analysis of the 2015 National Health Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137861. [PMID: 35805519 PMCID: PMC9265725 DOI: 10.3390/ijerph19137861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023]
Abstract
Maternity health care services utilization determines maternal and neonate outcomes. Evidence about factors associated with composite non-utilization of four or more antenatal consultations and intrapartum health care services is needed in Mozambique. This study uses data from the 2015 nationwide Mozambique’s Malaria, Immunization and HIV Indicators Survey. At selected representative households, women (n = 2629) with child aged up to 3 years answered a standardized structured questionnaire. Adjusted binary logistic regression assessed associations between women-child pairs characteristics and non-utilization of maternity health care. Seventy five percent (95% confidence interval (CI) = 71.8–77.7%) of women missed a health care cascade step during their last pregnancy. Higher education (adjusted odds ratio (AOR) = 0.65; 95% CI = 0.46–0.91), lowest wealth (AOR = 2.1; 95% CI = 1.2–3.7), rural residency (AOR = 1.5; 95% CI = 1.1–2.2), living distant from health facility (AOR = 1.5; 95% CI = 1.1–1.9) and unknown HIV status (AOR = 1.9; 95% CI = 1.4–2.7) were factors associated with non-utilization of the maternity health care cascade. The study highlights that, by 2015, recommended maternity health care cascade utilization did not cover 7 out of 10 pregnant women in Mozambique. Unfavorable sociodemographic and economic factors increase the relative odds for women not being covered by the maternity health care cascade.
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Availability and Use of Mobile Health Technology for Disease Diagnosis and Treatment Support by Health Workers in the Ashanti Region of Ghana: A Cross-Sectional Survey. Diagnostics (Basel) 2021; 11:diagnostics11071233. [PMID: 34359316 PMCID: PMC8307884 DOI: 10.3390/diagnostics11071233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 11/22/2022] Open
Abstract
Mobile health (mHealth) technologies have been identified as promising strategies for improving access to healthcare delivery and patient outcomes. However, the extent of availability and use of mHealth among healthcare professionals in Ghana is not known. The study’s main objective was to examine the availability and use of mHealth for disease diagnosis and treatment support by healthcare professionals in the Ashanti Region of Ghana. A cross-sectional survey was carried out among 285 healthcare professionals across 100 primary healthcare clinics in the Ashanti Region with an adopted survey tool. We obtained data on the participants’ background, available health infrastructure, healthcare workforce competency, ownership of a mobile wireless device, usefulness of mHealth, ease of use of mHealth, user satisfaction, and behavioural intention to use mHealth. Descriptive statistics were conducted to characterise healthcare professionals’ demographics and clinical features. Multivariate logistic regression analysis was performed to explore the influence of the demographic factors on the availability and use of mHealth for disease diagnosis and treatment support. STATA version 15 was used to complete all the statistical analyses. Out of the 285 healthcare professionals, 64.91% indicated that mHealth is available to them, while 35.08% have no access to mHealth. Of the 185 healthcare professionals who have access to mHealth, 98.4% are currently using mHealth to support healthcare delivery. Logistic regression model analysis significantly (p < 0.05) identified that factors such as the availability of mobile wireless devices, phone calls, text messages, and mobile apps are associated with HIV, TB, medication adherence, clinic appointments, and others. There is a significant association between the availability of mobile wireless devices, text messages, phone calls, mobile apps, and their use for disease diagnosis and treatment compliance from the chi-square test analysis. The findings demonstrate a low level of mHealth use for disease diagnosis and treatment support by healthcare professionals at rural clinics. We encourage policymakers to promote the implementation of mHealth in rural clinics.
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Daca C, Sebastian MS, Arnaldo C, Schumann B. Socio-economic and demographic factors associated with reproductive and child health preventive care in Mozambique: a cross-sectional study. Int J Equity Health 2020; 19:200. [PMID: 33168017 PMCID: PMC7653841 DOI: 10.1186/s12939-020-01303-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background Reproductive and child health interventions are essential to improving population health in Africa. In Mozambique, although some progress on reproductive and child health has been made, knowledge of social inequalities in health and health care is lacking. Objective To investigate socio-economic and demographic inequalities in reproductive and child preventive health care as a way to monitor progress towards universal health coverage. Methods A cross-sectional study was conducted, using data collected from the 2015 Immunization, AIDS and Malaria Indicators Survey (IMASIDA) in Mozambique. The sample included 6946 women aged 15 to 49 years. Outcomes variables were the use of insecticide treated nets (ITN) for children under 5 years, full child immunization and modern contraception use, while independent variables included age, marital status, place of residence, region, education, occupation, and household wealth index. Prevalence ratios (PR) with 95% confidence intervals (95% CI) were calculated by log binomial regression to assess the relationship between the socio-economic and demographic characteristics and the three outcomes of interest. Results The percentage of mothers with at least one child under 5 years that did not use ITN was 51.01, 46.25% of women had children aged 1 to 4 years who were not fully immunized, and 74.28% of women were not using modern contraceptives. Non-educated mothers (PR = 1.33; 95% CI: 1.16–1.51) and those living in the Southern region (PR = 1.36; 95% CI: 1.17–1.59) had higher risk of not using ITN, while the poorest quintile (PR = 1.34; 95% CI: 1.04–1.71) was more likely to have children who were not fully immunized. Similarly, non-educated women (PR = 1.17; 95% CI: 1.10–1.25), non-working women (PR = 1.09; 95% CI: 1.04–1.16), and those in the poorest quintile (PR = 1.13; 95% CI: 1.04–1.24) had a higher risk of not using modern contraceptives. Conclusion Our study showed a low rate of ITN utilization, immunization coverage of children, and modern contraceptive use among women of reproductive age. Several socio-economic and demographics factors (region, education, occupation, and wealth) were associated with these preventive measures. We recommend an equity-oriented resource allocation across regions, knowledge dissemination on the importance of ITN and contraceptives use, and an expansion of immunization services to reach socio-economically disadvantaged families in order to achieve universal health coverage in Mozambique.
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Affiliation(s)
- Chanvo Daca
- Ministry of Health, Directorate of Planning and Cooperation, Maputo, Mozambique. .,Department of Epidemiology and Global Health, Umea University, Umea, Sweden.
| | | | | | - Barbara Schumann
- Department of Epidemiology and Global Health, Umea University, Umea, Sweden
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Llop-Gironés A, Cash-Gibson L, Chicumbe S, Alvarez F, Zahinos I, Mazive E, Benach J. Health equity monitoring is essential in public health: lessons from Mozambique. Global Health 2019; 15:67. [PMID: 31847863 PMCID: PMC6918557 DOI: 10.1186/s12992-019-0508-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/11/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Countries must be able to describe and monitor their populations health and well-being needs in an attempt to understand and address them. The Sustainable Development Goals (SDGs) have re-emphasized the need to invest in comprehensive health information systems to monitor progress towards health equity; however, knowledge on the capacity of health information systems to be able do this, particularly in low-income countries, remains very limited. As a case study, we aimed to evaluate the current capacity of the national health information systems in Mozambique, and the available indicators to monitor health inequalities, in line with SDG 3 (Good Health and Well Being for All at All Ages). METHODS A data source mapping of the health information system in Mozambique was conducted. We followed the World Health Organization's methodology of assessing data sources to evaluate the information available for every equity stratifier using a three-point scale: 1 - information is available, 2 - need for more information, and 3 - an information gap. Also, for each indicator we estimated the national average inequality score. RESULTS Eight data sources contain health information to measure and monitor progress towards health equity in line with the 27 SDG3 indicators. Seven indicators bear information with nationally funded data sources, ten with data sources externally funded, and ten indicators either lack information or it does not applicable for the matter of the study. None of the 27 indicators associated with SDG3 can be fully disaggregated by equity stratifiers; they either lack some information (15 indicators) or do not have information at all (nine indicators). The indicators that contain more information are related to maternal and child health. CONCLUSIONS There are important information gaps in Mozambique's current national health information system which prevents it from being able to comprehensively measure and monitor health equity. Comprehensive national health information systems are an essential public health need. Significant policy and political challenges must also be addressed to ensure effective interventions and action towards health equity in the country.
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Affiliation(s)
- Alba Llop-Gironés
- Health Inequalities Research Group-Employment Conditions Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain
- Johns Hopkins University University Pompeu Fabra Public Policy Center, Barcelona, Spain
- GREDS-EMCONET, Department of Political and Social Sciences, Universitat Pompeu Fabra, Ramon Trias Fargas 25-27, 08003 Barcelona, Spain
| | - Lucinda Cash-Gibson
- Health Inequalities Research Group-Employment Conditions Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain
- Johns Hopkins University University Pompeu Fabra Public Policy Center, Barcelona, Spain
- GREDS-EMCONET, Department of Political and Social Sciences, Universitat Pompeu Fabra, Ramon Trias Fargas 25-27, 08003 Barcelona, Spain
| | - Sergio Chicumbe
- National Institute of Health, Ministry of Health of Mozambique, Maputo, Mozambique
- Instituto Nacional de Saude, Eduardo Mondlane Ave, 1008 Maputo, Mozambique
| | - Francesc Alvarez
- Medicus Mundi Mediterrània, Secretari Coloma st 112, 08024 Barcelona, Spain
| | - Ivan Zahinos
- Medicus Mundi Mediterrània, Secretari Coloma st 112, 08024 Barcelona, Spain
| | - Elisio Mazive
- National Institute of Statistics of Mozambique, Maputo, Mozambique
- Instituto Nacional de Estatística, 24 de Julho Ave, 1989 Maputo, Mozambique
| | - Joan Benach
- Health Inequalities Research Group-Employment Conditions Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain
- Johns Hopkins University University Pompeu Fabra Public Policy Center, Barcelona, Spain
- GREDS-EMCONET, Department of Political and Social Sciences, Universitat Pompeu Fabra, Ramon Trias Fargas 25-27, 08003 Barcelona, Spain
- Grupo de Investigación Transdisciplinar sobre Transiciones Socioecológicas (GinTRANS2), Universidad Autónoma de Madrid, Madrid, Spain
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