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Aragaw FM, Atlie G, Tesfaye AH, Belay DG. Spatial variation of skilled birth attendance and associated factors among reproductive age women in Ethiopia, 2019; a spatial and multilevel analysis. Front Glob Womens Health 2024; 5:1082670. [PMID: 39188539 PMCID: PMC11345201 DOI: 10.3389/fgwh.2024.1082670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 07/16/2024] [Indexed: 08/28/2024] Open
Abstract
Background The majority of maternal deaths were associated with a lack of access to skilled birth attendance. Because childbirth accounts for most maternal deaths, skilled birth attendance is crucial for reducing maternal mortality. The use of skilled birth attendance in Ethiopia is low, and it is crucial to identify factors that determine the use of skilled birth attendance. Hence, this study aimed to assess the spatial distribution, wealth-related inequality, and determinants for skilled birth attendance in Ethiopia. Methods Secondary data analysis was done with a total weighted sample of 5,251 reproductive-aged women using the 2019 mini EDHS. The concentration index and graph were used to assess wealth-related inequalities. Spatial analysis was done to identify the spatial distribution and multilevel logistic regression analysis was used to identify predictors of skilled birth attendance in Ethiopia. Analysis was done using STATA version 14, ArcGIS, and SaTscan software. Results The prevalence of skilled birth attendance was 50.04% (95% CI: 48.69%, 51.40%) in Ethiopia. Old age, being married, being educated, having television and radio, having ANC visits, being multiparous, having large household sizes, having a rich wealth index, living in rural residence, and living in a high level of community poverty and women's education were significant predictors of skilled birth attendance. Skilled birth attendance was disproportionately concentrated in rich households [C = 0.482; 95% CI: 0.436, 0.528]. High prevalence of unskilled birth attendance was found in Somalia, SNNP, Afar, and southern parts of the Amhara regions. Primary clusters of unskilled birth attendance Somalia and some parts of Oromia region of Ethiopia. Conclusion Half of the women in Ethiopia did not utilize skilled birth attendants with significant spatial clustering. Age, marital status, educational status, ANC Visit, having television and radio, parity, household size, wealth index, residence, community level poverty, and community level of women's education were significant predictors of skilled birth attendance. Skilled birth attendance was unevenly concentrated in rich households. The regions of Somalia, SNNP, Afar, and southern Amhara were identified as having a high prevalence of using unskilled birth attendance. Public health interventions should target those women at high risk of using unskilled birth attendants.
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Affiliation(s)
- Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gela Atlie
- Department of Internal Medicine, College of Medicine and Health Sciences, Madda Walabu University, Goba, Oromia, Ethiopia
| | - Amensisa Hailu Tesfaye
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Nyasulu PS, Ngamasana E, Kandala NB. Sources of Health Care Among Under-5 Malawian Children With Diarrhea Episodes: An Analysis of the 2017 Demographic and Health Survey. Glob Pediatr Health 2019; 6:2333794X19855468. [PMID: 31259208 PMCID: PMC6589950 DOI: 10.1177/2333794x19855468] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 05/13/2019] [Accepted: 05/15/2019] [Indexed: 11/16/2022] Open
Abstract
Diarrhea is a leading cause of morbidity and mortality in the world but mostly in Sub-Saharan Africa. These could be prevented if universal coverage of current available interventions were implemented. The study aimed to identify factors associated with the choice of health care source among caretakers seeking treatment for under-5 children with diarrhea illness. Using women's questionnaire we extracted a subset of data of children aged 0 to 59 months from the 2017 Demographic & Health Survey. Questions regarding history of childhood diarrhea for the past 24 hours or last 2 weeks prior to the survey were key in data extraction. Caregivers were asked to report the place where they sought treatment. In this study, 4 types of health facilities were defined: public, private, pharmacies, and other unspecified sources. A multinomial logistic regression model was used to identify sources of health facility used and corresponding factors associated with the choice. Factors associated with choice of health care source included education (educated women were less likely to self-medicate their children [relative risk ration (RRR) = 0.46; 95% confidence interval (CI) = 0.22-0.94]), income (better income earning families were more likely to seek care from private facility such as pharmacy [RRR = 1.87; 95% CI = 1.14-3.09]), and rural living (those in rural areas were more likely to seek treatment from other unspecified sources [RRR = 7.33, 95% CI = 1.40-38.36]). Public health facilities (79.9%) were the main source of health care service; however, reducing under-5 mortality due to diarrhea illness would require significant efforts to address other inequalities in accessing and utilizing health care services.
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Affiliation(s)
- Peter Suwirakwenda Nyasulu
- Division of Epidemiology & Biostatistics, Department of Global Health, Faculty of Health Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.,Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Ngianga-Bakwin Kandala
- Northumbria University, Department of Mathematics, Physics and Electrical Engineering, Faculty of Engineering and Environment, Newcastle upon Tyne, UK.,Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Dassi Tchoupa Revegue MH, Marin B, Ibinga E, Boumediene F, Preux PM, Ngoungou EB. Meta-analysis of perinatal factors associated with epilepsy in tropical countries. Epilepsy Res 2018; 146:54-62. [DOI: 10.1016/j.eplepsyres.2018.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/27/2018] [Accepted: 07/14/2018] [Indexed: 12/18/2022]
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Atuoye KN, Amoyaw JA, Kuuire VZ, Kangmennaang J, Boamah SA, Vercillo S, Antabe R, McMorris M, Luginaah I. Utilisation of skilled birth attendants over time in Nigeria and Malawi. Glob Public Health 2018; 12:728-743. [PMID: 28441927 DOI: 10.1080/17441692.2017.1315441] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Despite recent modest progress in reducing maternal and infant mortality rates in sub-Saharan Africa, Nigeria and Malawi were still in the top 20 countries with highest rates of mortalities globally in 2015. Utilisation of professional services at delivery - one of the indictors of MDG 5 - has been suggested to reduce maternal mortality by 50%. Yet, contextual, socio-cultural and economic factors have served as barriers to uptake of such critical service. In this paper, we examined the impact of residential wealth index on utilisation of Skilled Birth Attendant in Nigeria (2003, 2008 and 2013), and Malawi (2000, 2004 and 2010) using Demographic and Health Survey data sets. The findings from multivariate logistic regressions show that women in Nigeria were 23% less likely to utilise skilled delivery services in 2013 compared to 2003. In Malawi, women were 75% more likely to utilise skilled delivery services in 2010 than in 2000. Residential wealth index was a significant predictor of utilisation of skilled delivery services over time in both Nigeria and Malawi. These findings illuminate progress made - based on which we make recommendations for achievement of SDG-3: ensure healthy lives and promote well-being for all at all ages in Nigeria and Malawi, and similar context.
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Affiliation(s)
- Kilian N Atuoye
- a Environmental Health and Hazards Lab, Department of Geography , University of Western Ontario , London , Canada
| | - Jonathan A Amoyaw
- b Department of Sociology , University of Western Ontario , London , Canada
| | - Vincent Z Kuuire
- c Department of Geography and Planning , Queen's University , Kingston , Canada
| | - Joseph Kangmennaang
- d Department of Geography and Environmental Management , University of Waterloo , Waterloo , Canada
| | - Sheila A Boamah
- e Arthur Labatt Family School of Nursing, Health Sciences Addition , University of Western Ontario , London , Canada
| | - Siera Vercillo
- a Environmental Health and Hazards Lab, Department of Geography , University of Western Ontario , London , Canada
| | - Roger Antabe
- a Environmental Health and Hazards Lab, Department of Geography , University of Western Ontario , London , Canada
| | - Meghan McMorris
- a Environmental Health and Hazards Lab, Department of Geography , University of Western Ontario , London , Canada
| | - Isaac Luginaah
- f Department of Geography , University of Western Ontario , London , Canada
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Kuuire VZ, Kangmennaang J, Atuoye KN, Antabe R, Boamah SA, Vercillo S, Amoyaw JA, Luginaah I. Timing and utilisation of antenatal care service in Nigeria and Malawi. Glob Public Health 2017; 12:711-727. [DOI: 10.1080/17441692.2017.1316413] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Vincent Z. Kuuire
- Department of Geography and Planning, Queen’s University, Kingston, ON, Canada
| | - Joseph Kangmennaang
- Department of Geography and Environmental Management, University of Waterloo, Waterloo, ON, Canada
| | - Kilian N. Atuoye
- Environmental Health and Hazards Lab, Department of Geography, University of Western Ontario, London, ON, Canada
| | - Roger Antabe
- Environmental Health and Hazards Lab, Department of Geography, University of Western Ontario, London, ON, Canada
| | - Sheila A. Boamah
- Arthur Labatt Family School of Nursing, Health Sciences Addition, University of Western Ontario, London, ON, Canada
| | - Siera Vercillo
- Environmental Health and Hazards Lab, Department of Geography, University of Western Ontario, London, ON, Canada
| | - Jonathan A. Amoyaw
- Department of Sociology, University of Western Ontario, London, ON, Canada
| | - Isaac Luginaah
- Department of Geography, University of Western Ontario, London, ON, Canada
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Jacobs C, Moshabela M, Maswenyeho S, Lambo N, Michelo C. Predictors of Antenatal Care, Skilled Birth Attendance, and Postnatal Care Utilization among the Remote and Poorest Rural Communities of Zambia: A Multilevel Analysis. Front Public Health 2017; 5:11. [PMID: 28239604 PMCID: PMC5299018 DOI: 10.3389/fpubh.2017.00011] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 01/20/2017] [Indexed: 11/13/2022] Open
Abstract
Objective Optimal utilization of maternal health-care services is associated with reduction of mortality and morbidity for both mothers and their neonates. However, deficiencies and disparity in the use of key maternal health services within most developing countries still persist. We examined patterns and predictors associated with the utilization of specific indicators for maternal health services among mothers living in the poorest and remote district populations of Zambia. Methods A cross-sectional baseline household survey was conducted in May 2012. A total of 551 mothers with children between the ages 0 and 5 months were sampled from 29 catchment areas in four rural and remote districts of Zambia using the lot quality assurance sampling method. Using multilevel modeling, we accounted for individual- and community-level factors associated with utilization of maternal health-care services, with a focus on antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC). Results Utilization rates of focused ANC, SBA, and PNC within 48 h were 30, 37, and 28%, respectively. The mother’s ability to take an HIV test and receiving test results and uptake of intermittent preventive treatment for malaria were positive predictors of focused ANC. Receiving ANC at least once from skilled personnel was a significant predictor of SBA and PNC within 48 h after delivery. Women who live in centralized rural areas were more likely to use SBA than those living in remote rural areas. Conclusion Utilization of maternal health services by mothers living among the remote and poor marginalized populations of Zambia is much lower than the national averages. Finding that women that receive ANC once from a skilled attendant among the remote and poorest populations are more likely to have a SBA and PNC, suggests the importance of contact with a skilled health worker even if it is just once, in influencing use of services. Therefore, it appears that in order for women in these marginalized communities to benefit from SBA and PNC, it is important for them to have at least one ANC provided by a skilled personnel, rather than non-skilled health-care providers.
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Affiliation(s)
- Choolwe Jacobs
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Mosa Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; Africa Centre for Population Health, Mtubatuba, South Africa
| | | | | | - Charles Michelo
- Department of Public Health, School of Medicine, University of Zambia , Lusaka , Zambia
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Luginaah IN, Kangmennaang J, Fallah M, Dahn B, Kateh F, Nyenswah T. Timing and utilization of antenatal care services in Liberia: Understanding the pre-Ebola epidemic context. Soc Sci Med 2016; 160:75-86. [DOI: 10.1016/j.socscimed.2016.05.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/08/2016] [Accepted: 05/10/2016] [Indexed: 02/02/2023]
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Luexay P, Malinee L, Pisake L, Marie-Hélène BC. Maternal near-miss and mortality in Sayaboury Province, Lao PDR. BMC Public Health 2014; 14:945. [PMID: 25213771 PMCID: PMC4177158 DOI: 10.1186/1471-2458-14-945] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 09/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal near-miss (MNM) incidence is the indicator reflecting maternal healthcare services. This study aimed to determine the burden of maternal near-miss and maternal deaths in Sayaboury Province, Lao PDR. METHODS A descriptive study was done in a cohort of 1215 pregnant women, who had their last normal menstrual period (LMP) between 1 August and 31 December, 2010. WHO criteria for MNM were used to identify near-miss cases and maternal deaths during February-November 2011. Data of maternal characteristics, MNM, and maternal deaths were prospectively collected by primary health care workers in the villages under supervision of health staff in local health centers and by the head nurses of the gynecology-obstetric wards in the studied hospitals. Frequencies with 95% confidence intervals (CIs) were used to describe maternal near-misses and maternal deaths. RESULTS Overall, 92.5% of the 1215 pregnancies were delivered, 7.5% were aborted. Eleven women were identified as near-miss cases, giving a maternal near miss (MNM) ratio of 9.8 (95% CI: 4.9-17.5)/1,000 live births. With two maternal deaths, the maternal mortality ratio (MMR) was 178 (95% CI: 50-650)/100,000 live births. Together, these constituted 13 cases of severe maternal outcome (SMO) and given the SMO ratio of 11.6 (95% CI: 6.2-19.8)/1,000 live births. CONCLUSION The study shows a surprisingly low MNM ratio and MMR in Sayaboury Province, Lao PDR. Generalization of the results is limited by problems in applying standard criteria for the identification of near-misses in the communities and local hospitals. However, the findings are considered to have important implications for the improvement of maternal health services in low resource settings, e.g. to obtain valid and reliable maternal near miss and maternal deaths for the whole country.
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Affiliation(s)
| | - Laopaiboon Malinee
- Department of Biostatistics and Demography, Faculty of Public Health, Khon Kaen University, 123 Mittapharp Road, 40002 Muaeng district, Khon Kaen, Thailand.
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Kanu JS, Tang Y, Liu Y. Assessment on the knowledge and reported practices of women on maternal and child health in rural Sierra Leone: a cross-sectional survey. PLoS One 2014; 9:e105936. [PMID: 25166504 PMCID: PMC4148396 DOI: 10.1371/journal.pone.0105936] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 07/30/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Globally, Sierra Leone is ranked among the countries with the worst maternal and child health indicators. The mortality of women and children is significantly higher compared with other developing countries. The death of women and children can be prevented by simple cost-effective community-based interventions. The aim of this present study was to learn the knowledge levels of women on maternal and child health, and treatment-seeking and preventive behaviours in rural Sierra Leone and provide appropriate suggestions for policy makers. Moreover, the study also aimed to evaluate the effect of a husband's involvement on health knowledge and practices of women in rural Sierra Leone. METHODS Women with at least a child of five years or below were interviewed in their households through a structured questionnaire. Characteristics of the households and of the respondents were collected and the number of correct answers given to the health knowledge and practice questions and their percentage distributions were tabulated and an overall health knowledge score was calculated. RESULTS The mean score of the derived overall health-related knowledge was 61.6% (maximum of 91% and a minimum of 18%) with a standard deviation of 14.7% and a median of 63.3%. Multivariable regression analyses showed education and number of pregnancies are associated with knowledge score, with significantly improved health knowledge scores amongst those who accessed higher education. There were some inappropriate practices in hygiene and sanitation. However, vaccination coverage was high with almost 100% coverage for BCG. CONCLUSIONS Based on the findings of this study, women's knowledge on maternal and child health care are inadequate in rural Sierra Leone. Health promotion activities focusing on prevention of diarrhoea, malaria and pneumonia, improvement in health-related knowledge on pregnancy, delivery, neonatal care and environmental sanitation would be invaluable.
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Affiliation(s)
- Joseph Sam Kanu
- Department of Epidemiology & Biostatistics, School of Public Health, Jilin University, Changchun City, Jilin Province, P. R. China
| | - Yuan Tang
- Department of Epidemiology & Biostatistics, School of Public Health, Jilin University, Changchun City, Jilin Province, P. R. China
| | - Yawen Liu
- Department of Epidemiology & Biostatistics, School of Public Health, Jilin University, Changchun City, Jilin Province, P. R. China
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Adjiwanou V, LeGrand T. Gender inequality and the use of maternal healthcare services in rural sub-Saharan Africa. Health Place 2014; 29:67-78. [PMID: 24994096 DOI: 10.1016/j.healthplace.2014.06.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 05/17/2014] [Accepted: 06/04/2014] [Indexed: 11/30/2022]
Abstract
In this study, we measure gender inequality both at individual level by women׳s household decision-making and at contextual level by permissive gender norms associated with tolerance of violence against women and assess their impact on maternal healthcare services utilisation in rural Africa. We apply multilevel structural equation modelling to Demographic and Health Survey (DHS) data from Ghana, Kenya, Tanzania and Uganda to gain better measure and effect of the gender norms construct. The results show that women in Ghana and Uganda, who live in areas where gender norms are relatively tolerant of violence against women, are less likely to use skilled birth attendants and timely antenatal care. In Tanzania, women who live in this type of environment are less likely to attend four or more antenatal visits. In contrast, the effects of a woman׳s decision-making authority on maternal health service use are less pronounced in the same countries.
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Affiliation(s)
- Vissého Adjiwanou
- Centre for Actuarial Research (CARe), University of Cape Town, South Africa.
| | - Thomas LeGrand
- Département de Démographie, Université de Montréal, Canada
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Bateman‐Steel CR. Women Deliver 2013: taking a gender lens to the new global health and development agenda. Med J Aust 2013; 199:733-4. [DOI: 10.5694/mja13.10890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 10/13/2013] [Indexed: 11/17/2022]
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Manasyan A, Saleem S, Koso-Thomas M, Althabe F, Pasha O, Chomba E, Goudar SS, Patel A, Esamai F, Garces A, Kodkany B, Belizan J, McClure EM, Derman RJ, Hibberd P, Liechty EA, Hambidge KM, Carlo WA, Buekens P, Moore J, Wright LL, Goldenberg RL. Assessment of obstetric and neonatal health services in developing country health facilities. Am J Perinatol 2013; 30:787-94. [PMID: 23329566 PMCID: PMC3664648 DOI: 10.1055/s-0032-1333409] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe the staffing and availability of medical equipment and medications and the performance of procedures at health facilities providing maternal and neonatal care at African, Asian, and Latin American sites participating in a multicenter trial to improve emergency obstetric/neonatal care in communities with high maternal and perinatal mortality. STUDY DESIGN In 2009, prior to intervention, we surveyed 136 hospitals and 228 clinics in 7 sites in Africa, Asia, and Latin America regarding staffing, availability of equipment/medications, and procedures including cesarean section. RESULTS The coverage of physicians and nurses/midwives was poor in Africa and Latin America. In Africa, only 20% of hospitals had full-time physicians. Only 70% of hospitals in Africa and Asia had performed cesarean sections in the last 6 months. Oxygen was unavailable in 40% of African hospitals and 17% of Asian hospitals. Blood was unavailable in 80% of African and Asian hospitals. CONCLUSIONS Assuming that adequate facility services are necessary to improve pregnancy outcomes, it is not surprising that maternal and perinatal mortality rates in the areas surveyed are high. The data presented emphasize that to reduce mortality in these areas, resources that result in improved staffing and sufficient equipment, supplies, and medication, along with training, are required.
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Mpemba F, Kampo S, Zhang X. Towards 2015: post-partum haemorrhage in sub-Saharan Africa still on the rise. J Clin Nurs 2013; 23:774-83. [PMID: 23472972 DOI: 10.1111/jocn.12126] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Faraja Mpemba
- Department of Nursing; Dalian Medical University; Dalian China
| | - Sylvanus Kampo
- Department of Anaesthesiology; Dalian Medical University; Dalian China
| | - Xinyu Zhang
- Department of Obstetrics & Gynecology; First Affiliated Hospital of Dalian Medical University; Dalian China
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Ruhago GM, Ngalesoni FN, Norheim OF. Addressing inequity to achieve the maternal and child health millennium development goals: looking beyond averages. BMC Public Health 2012; 12:1119. [PMID: 23270489 PMCID: PMC3543393 DOI: 10.1186/1471-2458-12-1119] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 12/22/2012] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Inequity in access to and use of child and maternal health interventions is impeding progress towards the maternal and child health Millennium Development Goals. This study explores the potential health gains and equity impact if a set of priority interventions for mothers and under fives were scaled up to reach national universal coverage targets for MDGs in Tanzania. METHODS We used the Lives Saved Tool (LiST) to estimate potential reductions in maternal and child mortality and the number of lives saved across wealth quintiles and between rural and urban settings. High impact maternal and child health interventions were modelled for a five-year scale up, by linking intervention coverage, effectiveness and cause of mortality using data from Tanzania. Concentration curves were drawn and the concentration index estimated to measure the equity impact of the scale up. RESULTS In the poorest population quintiles in Tanzania, the lives of more than twice as many mothers and under-fives were likely to be saved, compared to the richest quintile. Scaling up coverage to equal levels across quintiles would reduce inequality in maternal and child mortality from a pro rich concentration index of -0.11 (maternal) and -0.12 (children) to a more equitable concentration index of -0,03 and -0.03 respectively. In rural areas, there would likely be an eight times greater reduction in maternal deaths than in urban areas and a five times greater reduction in child deaths than in urban areas. CONCLUSIONS Scaling up priority maternal and child health interventions to equal levels would potentially save far more lives in the poorest populations, and would accelerate equitable progress towards maternal and child health MDGs.
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Affiliation(s)
- George M Ruhago
- School of Public Health and Social Sciences, Muhimbili University, P.O Box 65015, Dar es Salaam, Tanzania
- Department of Public Health and Primary Health Care and Centre for International Health Kalfarveien 18, University of Bergen, Bergen, 5018, Norway
| | - Frida N Ngalesoni
- Ministry of Health and Social Welfare, P.O Box 9083, Dar es Salaam, Tanzania
- Department of Public Health and Primary Health Care and Centre for International Health Kalfarveien 18, University of Bergen, Bergen, 5018, Norway
| | - Ole F Norheim
- Department of Public Health and Primary Health Care and Centre for International Health Kalfarveien 18, University of Bergen, Bergen, 5018, Norway
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Bucagu M, Kagubare JM, Basinga P, Ngabo F, Timmons BK, Lee AC. Impact of health systems strengthening on coverage of maternal health services in Rwanda, 2000-2010: a systematic review. REPRODUCTIVE HEALTH MATTERS 2012; 20:50-61. [PMID: 22789082 DOI: 10.1016/s0968-8080(12)39611-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
From 2000 to 2010, Rwanda implemented comprehensive health sector reforms to strengthen the public health system, with the aim of reducing maternal and newborn deaths in line with Millennium Development Goal 5, among many other improvements in national health. Based on a systematic review of the literature, national policy documents and three Demographic & Health Surveys (2000, 2005 and 2010), this paper describes the reforms and the policies they were based on, and provides data on the extent of Rwanda's progress in expanding the coverage of four key women's health services. Progress took place in 2000-2005 and became more rapid after 2006, mostly in rural areas, when the national facility-based childbirth policy, performance-based financing, and community-based health insurance were scaled up. Between 2006 and 2010, the following increases in coverage took place as compared to 2000-2005, particularly in rural areas, where most poor women live: births with skilled attendance (77% increase vs. 26%), institutional delivery (146% increase vs. 8%), and contraceptive prevalence (351% increase vs. 150%). The primary factors in these improvements were increases in the health workforce and their skills, performance-based financing, community-based health insurance, and better leadership and governance. Further research is needed to determine the impact of these changes on health outcomes in women and children.
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Affiliation(s)
- Maurice Bucagu
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland.
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Burton KJ, Rogathe J, Whittaker R, Mankad K, Hunter E, Burton MJ, Todd J, Neville BGR, Walker R, Newton CRJC. Epilepsy in Tanzanian children: association with perinatal events and other risk factors. Epilepsia 2012; 53:752-60. [PMID: 22308971 PMCID: PMC3467761 DOI: 10.1111/j.1528-1167.2011.03395.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Purpose To define the prevalence and risk factors for epilepsy in children in a rural district of Tanzania by conducting a community-based case–control study. Methods Children aged 6–14 years with active epilepsy (at least two unprovoked seizures in the last 5 years) were identified in a cross-sectional survey in Tanzania. Cases were compared with age-matched controls. Key Findings Overall 112 children with epilepsy (CWE) were identified; the unadjusted prevalence of epilepsy was 2.91 per 1,000 (95% confidence interval [95% CI] 2.4–3.5). The main seizure types were focal motor with secondary generalization in 73 (65.2%) of 112 and generalized convulsive seizures in 19 (16.9%) of 112. Adverse perinatal events were present in 16 (14%) of 112 cases but in no controls. In multivariate analysis, epilepsy was associated with number of parents who were resident at home (odds ratio [OR] 6.2 for none vs. both resident, 95% CI 1.5–25.5), history of adverse perinatal events (OR 14.9, 95% CI 1.4–151.3), family history of afebrile seizures (OR 5.7, 95% CI 1.0–27.5), and poor scholastic attainment (OR 8.6, 95% CI 4.0–18.4). Electroencephalography (EEG) and computed tomography (CT) scans were abnormal in 44 (44%) of 101 and 26 (29%) of 90 cases, respectively. Overall, 98 (88%) of 112 cases had focal features on assessment. Significance In this study from sub-Saharan Africa, CWE predominantly had focal features that support the suggestion that most epilepsy in this region has a symptomatic etiology. Adverse perinatal events were strongly associated with epilepsy. Genetic and social factors may also be important. Epilepsy may be preventable in a significant proportion of children with better antenatal and perinatal care.
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Calhoun JG, Spencer HC, Buekens P. Competencies for global heath graduate education. Infect Dis Clin North Am 2012; 25:575-92, viii. [PMID: 21896359 DOI: 10.1016/j.idc.2011.02.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Competency specification and competency-based education (CBE) are increasingly being viewed as essential for optimizing educational outcomes for the next generation of global health workers. An overview is provided of this movement in graduate health professions education in the United States, the Association of Schools of Public Health (ASPH) contributions to advancing and researching related CBE processes and best practices, and the evolving ASPH competency model for graduate global health education.
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Affiliation(s)
- Judith G Calhoun
- Medical School, University of Michigan, 300 Huntington Drive, Suite 5100, Ann Arbor, MI 48104-1820, USA.
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Ezugwu EC, Onah H, Iyoke CA, Ezugwu FO. Obstetric outcome following free maternal care at Enugu State University Teaching Hospital (ESUTH), Parklane, Enugu, South-eastern Nigeria. J OBSTET GYNAECOL 2011; 31:409-12. [PMID: 21627424 DOI: 10.3109/01443615.2011.578227] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study aims to determine the impact of free maternal care on the utilisation of the available delivery services and to evaluate the obstetric outcome. All deliveries at ESUTH, Parklane within the 4 months of free maternal care from 1 September to 31( )December 2008 were studied and compared with deliveries that took place 4 months before and after the free services. The results were analysed using Epi-info statistical software version 3:2:2. There was an 88% rise in the number of deliveries with the introduction of free maternal services and a 30% drop within 4 months of its termination. The maternal mortality ratio (MMR) dropped slightly, but morbidity increased significantly, as well as stillbirth rate (77/1,000 births), especially intrapartum stillbirth. Cost barrier limits women's access to healthcare in developing countries and must be addressed if we aim to achieve Millennium Development Goals (MDGs) 4 and 5.
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Affiliation(s)
- E C Ezugwu
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Itukku-Ozalla, Enugu State, Nigeria.
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Bhuiyan AB, Goodall D. The role of the South Asia Federation of Obstetrics and Gynaecology (SAFOG) in South Asia. BJOG 2011; 118 Suppl 2:22-5. [DOI: 10.1111/j.1471-0528.2011.03107.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Haddad SM, Cecatti JG, Parpinelli MA, Souza JP, Costa ML, Sousa MH, Surita FG, Pinto E Silva JL, Pacagnella RC, Camargo RS, Bahamondes MV, Zotareli V, Gurgel LT, Say L, Pattinson RC. From planning to practice: building the national network for the Surveillance of Severe Maternal Morbidity. BMC Public Health 2011; 11:283. [PMID: 21549009 PMCID: PMC3101659 DOI: 10.1186/1471-2458-11-283] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 05/08/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving maternal health is one of the Millennium Development Goals for 2015. Recently some progress has been achieved in reducing mortality. On the other hand, in developed regions, maternal death is a relatively rare event compared to the number of cases of morbidity; hence studying maternal morbidity has become more relevant. Electronic surveillance systems may improve research by facilitating complete data reporting and reducing the time required for data collection and analysis. Therefore the purpose of this study was to describe the methods used in elaborating and implementing the National Network for the Surveillance of Severe Maternal Morbidity in Brazil. METHODS The project consisted of a multicenter, cross-sectional study for the surveillance of severe maternal morbidity including near-miss, in Brazil. RESULTS Following the development of a conceptual framework, centers were selected for inclusion in the network, consensus meetings were held among the centers, an electronic data collection system was identified, specific software and hardware tools were developed, research material was prepared, and the implementation process was initiated and analyzed. CONCLUSION The conceptual framework developed for this network was based on the experience acquired in various studies carried out in the area over recent years and encompasses maternal and perinatal health. It is innovative especially in the context of a developing country. The implementation of the project represents the first step towards this planned management. The system online elaborated for this surveillance network may be used in further studies in reproductive and perinatal health.
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Affiliation(s)
- Samira M Haddad
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil.
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Multidisciplinary team partnerships to improve maternal and neonatal outcomes: the Kybele experience. Int Anesthesiol Clin 2010; 48:109-22. [PMID: 20386231 DOI: 10.1097/aia.0b013e3181dd4f13] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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