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Hamilton EAA, Dornan L, Sinclair M, McCoy J, Hanna-Trainor L, Kernohan WG. A scoping review protocol: Mapping the range of policy-related evidence influencing maternal health outcomes in a fragile, low-income country. J Adv Nurs 2021; 77:4246-4253. [PMID: 34288043 DOI: 10.1111/jan.14956] [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: 02/23/2021] [Revised: 06/01/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022]
Abstract
AIM The aim of this scoping review is to map the range of policy-related evidence influencing maternal health outcomes and determine the cultural and contextual factors influencing maternal health in Myanmar, a low-income, fragile setting. DESIGN Eligible studies identified will include maternal health-related policies, policy documents and research. All types of health-related policies aimed at targeting population health and well-being influencing maternal mortality and morbidity will be considered. METHODS This scoping review has been developed using the Joanna Briggs Institute recommendations. The database search will include MEDLINE, CINAHL, Web of Science, Cochrane Library and the grey literature. Documents published in English and Burmese in the past 10 years will be included. Numerical data will be extracted and summarized in diagrammatic form, and a descriptive format will be used to present narrative accounts. Funding approval was granted by the Economic and Social Research Council in January 2020. This protocol was registered with OSF registries (Open-ended Registration) on 30 March 2021. DISCUSSION Little is known about which strategies work best as there is less evidence related to health policy and contextual factors in which maternal health care is delivered in fragile, low-income settings. Understanding the context of maternal health is key to the planning and implementation of effective maternal health services designed to address women's needs. IMPACT This review will map the range of policy-related evidence influencing maternal health outcomes in Myanmar and will underpin future large-scale research in other low-income and fragile settings. The results of this scoping review will provide recommendations for developing and improving practice and education for nurses and midwives working in resource-restricted contexts.
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Affiliation(s)
- E Adela A Hamilton
- Faculty of Life & Health Sciences, School of Nursing, University of Ulster, Belfast, Northern Ireland
| | - Lesley Dornan
- Faculty of Life & Health Sciences, School of Nursing, University of Ulster, Belfast, Northern Ireland
| | - Marlene Sinclair
- Faculty of Life & Health Sciences, School of Nursing, University of Ulster, Belfast, Northern Ireland
| | - Jackie McCoy
- Ulster University Business School, Global Business and Enterprise, University of Ulster, Belfast, Northern Ireland
| | - Lisa Hanna-Trainor
- Faculty of Life & Health Sciences, School of Nursing, University of Ulster, Belfast, Northern Ireland
| | - W George Kernohan
- Faculty of Life & Health Sciences, School of Nursing, University of Ulster, Belfast, Northern Ireland
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Delele TG, Biks GA, Abebe SM, Kebede ZT. Determinants of Health Facility Delivery in Northwest Ethiopia: A Community-Based Case-Control Study. Int J Gen Med 2021; 14:993-1001. [PMID: 33790628 PMCID: PMC8001102 DOI: 10.2147/ijgm.s300178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/05/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Although Ethiopia has developed many strategies to promote health facility delivery, more than half of the women gave birth at home contributing to high maternal and neonatal mortality. Therefore, this study aimed to identify the determinants of health facility delivery in Northwest Ethiopia. METHODS A community-based unmatched case-control study was conducted in selected districts in Northwest Ethiopia. The sample included 885 infant mothers (295 cases and 590 controls) from April 6-16, 2019. Data were collected using a pretested interviewer-administered structured questionnaire. A multivariable logistic regression model was used to identify predictors, and STATA 14 statistical software was used to analyze the data. RESULTS The mean maternal age was 26.4 years (SD±6.7) for cases and 28.1 years (SD±6.8) for controls. The overall good newborn care qualities were 95.8% (206) for cases and 40.8% (262) for controls. Attending a formal education (AOR=2.1 (95% CI: 1.5, 2.9)), having first pregnancy from 18 to 25 (AOR=1.5 (95% CI: 1.1, 2.1)), living within 1 km distance from the nearest health center (AOR=2.5 (95% CI: 1.5, 4.0)), having ANC visits (AOR=3.9 (95% CI: 2.4, 6.5)), having a mobile (AOR=1.7 (95% CI: 1.3, 2.4)) were the determinants of health facility delivery. CONCLUSION Maternal education, not having pregnancy at early age, accessing health facilities to the nearby residents, attending antenatal care, and having a mobile were the determinants of health facility delivery. Therefore, strengthening education and health-seeking behavior of the mothers using a locally contextualized strategy is essential. Reaching mothers who are still far from health facility also deserves needs due attention.
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Affiliation(s)
- Tadesse Guadu Delele
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gashaw Andargie Biks
- Departments of Health System and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon Mekonnen Abebe
- Departments of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zemene Tigabu Kebede
- Departments of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Baker C, Limato R, Tumbelaka P, Rewari BB, Nasir S, Ahmed R, Taegtmeyer M. Antenatal testing for anaemia, HIV and syphilis in Indonesia - a health systems analysis of low coverage. BMC Pregnancy Childbirth 2020; 20:326. [PMID: 32471383 PMCID: PMC7257553 DOI: 10.1186/s12884-020-02993-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 05/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adverse pregnancy outcomes can be prevented through the early detection and treatment of anaemia, HIV and syphilis during the antenatal period. Rates of testing for anaemia, HIV and syphilis among women attending antenatal services in Indonesia are low, despite its mandate in national guidelines and international policy. METHODS Midwife-held antenatal care records for 2015 from 8 villages in 2 sub-districts within Cianjur district were reviewed, alongside the available sub-district Puskesmas (Community Health Centre) maternity and laboratory records. We conducted four focus group discussions with kaders (community health workers) (n = 16) and midwives (n = 9), and 13 semi-structured interviews with laboratory and counselling, public sector maternity and HIV management and relevant non-governmental organisation staff. Participants were recruited from village, sub-district, district and national level as relevant to role. RESULTS We were unable to find a single recorded result of antenatal testing for HIV, syphilis or anaemia in the village (566 women) or Puskesmas records (2816 women) for 2015. Laboratory records did not specifically identify antenatal women. Participants described conducting and reporting testing in a largely ad hoc manner; relying on referral to health facilities based on clinical suspicion or separate non-maternity voluntary counselling and testing programs. Participants recognized significant systematic challenges with key differences between the more acceptable (and reportedly more often implemented) haemoglobin testing and the less acceptable (and barely implemented) HIV and syphilis testing. However, a clear need for leadership and accountability emerged as an important factor for prioritizing antenatal testing and addressing these testing gaps. CONCLUSIONS Practical solutions such as revised registers, availability of point-of-care tests and capacity building of field staff will therefore need to be accompanied by both funding and political will to coordinate, prioritize and be accountable for testing in pregnancy.
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Affiliation(s)
- C Baker
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - R Limato
- Eijkman Institute for Molecular Biology, Jl. Diponegoro No. 69, Jakarta, 10430, Indonesia
| | - P Tumbelaka
- Eijkman Institute for Molecular Biology, Jl. Diponegoro No. 69, Jakarta, 10430, Indonesia
| | - B B Rewari
- Division of Communicable Disease, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - S Nasir
- Faculty of Public Health, Universitas Hasanuddin, Makassar, Indonesia
| | - R Ahmed
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.,Eijkman Institute for Molecular Biology, Jl. Diponegoro No. 69, Jakarta, 10430, Indonesia
| | - M Taegtmeyer
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
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Cameron L, Contreras Suarez D, Cornwell K. Understanding the determinants of maternal mortality: An observational study using the Indonesian Population Census. PLoS One 2019; 14:e0217386. [PMID: 31158243 PMCID: PMC6546237 DOI: 10.1371/journal.pone.0217386] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 05/11/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND For countries to contribute to Sustainable Development Goal 3.1 of reducing the global maternal mortality ratio (MMR) to less than 70 per 100,000 live births by 2030, identifying the drivers of maternal mortality is critically important. The ability of countries to identify the key drivers is however hampered by the lack of data sources with sufficient observations of maternal death to allow a rigorous analysis of its determinants. This paper overcomes this problem by utilising census data. In the context of Indonesia, we merge individual-level data on pregnancy-related deaths and households' socio-economic status from the 2010 Indonesian population census with detailed data on the availability and quality of local health services from the Village Census. We use these data to test the hypothesis that health service access and quality are important determinants of maternal death and explain the differences between high maternal mortality and low maternal mortality provinces. METHODS The 2010 Indonesian Population Census identifies 8075 pregnancy-related deaths and 5,866,791 live births. Multilevel logistic regression is used to analyse the impacts of demographic characteristics and the existence of, distance to and quality of health services on the likelihood of maternal death. Decomposition analysis quantifies the extent to which the difference in maternal mortality ratios between high and low performing provinces can be explained by demographic and health service characteristics. FINDINGS Health service access and characteristics account for 23% (CI: 17.2% to 28.5%) of the difference in maternal mortality ratios between high and low-performing provinces. The most important contributors are the number of doctors working at the community health centre (8.6%), the number of doctors in the village (6.9%) and distance to the nearest hospital (5.9%). Distance to health clinics and the number of midwives at community health centres and village health posts are not significant contributors, nor is socio-economic status. If the same level of access to doctors and hospitals in lower maternal mortality Java-Bali was provided to the higher maternal mortality Outer Islands of Indonesia, our model predicts 44 deaths would be averted per 100,000 pregnancies. CONCLUSION Indonesia has employed a strategy over the past several decades of increasing the supply of midwives as a way of decreasing maternal mortality. While there is evidence of reductions in maternal mortality continuing to accrue from the provision of midwife services at village health posts, our findings suggest that further reductions in maternal mortality in Indonesia may require a change of focus to increasing the supply of doctors and access to hospitals. If data on maternal death is collected in a subsequent census, future research using two waves of census data would prove a useful validation of the results found here. Similar research using census data from other countries is also likely to be fruitful.
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Affiliation(s)
- Lisa Cameron
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, Victoria, Australia
- * E-mail:
| | - Diana Contreras Suarez
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Katy Cornwell
- Centre for Development Economics and Sustainability, Monash University, Clayton, Victoria, Australia
- World Vision Australia, Burwood East, Victoria, Australia
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Haruna U, Kansanga MM, Bagah DA. Repositioning traditional birth attendants to provide improved maternal healthcare services in rural Ghana. Int J Health Plann Manage 2019; 34:e987-e994. [PMID: 30945362 DOI: 10.1002/hpm.2779] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 11/10/2022] Open
Abstract
Following the World Health Organization's recommendation for developing countries to discontinue the use of Traditional Birth Attendants (TBAs) in rural areas, the government of Ghana banned TBAs from offering maternal health care services. Since this ban, community-level conflicts have intensified between TBAs, (who still see themselves as legitimate culturally mandated traditional midwives) and nurses. In this articles, we propose a partnership model for a sustainable resolution of these conflicts. This article emanates from the apparent ideological discontent between people from mainstream medical practice who advocate for the complete elimination of TBAs in the maternal health service space and individuals who argue for the inclusion of TBAs in the health sector given the shortage of skilled birth attendants and continued patronage of their services by rural women even in context where nurses are available. In the context of the longstanding manpower deficit in the health sector in Ghana, improving maternal healthcare in rural communities will require harnessing all locally available human resources. This cannot be achieved by "throwing out" a critical group of actors who have been involved in health-care provision for many decades. We propose a win-win approach that involve retraining of TBAs, partnership with health practitioners, and task shifting.
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Affiliation(s)
- Umar Haruna
- Department of Social, Political and Historical Studies, Faculty of Integrated Development Studies, University for Development Studies, Wa, Ghana
| | - Moses M Kansanga
- Department of Geography, University of Western Ontario, London, Canada
| | - Daniel A Bagah
- Department of Social, Political and Historical Studies, Faculty of Integrated Development Studies, University for Development Studies, Wa, Ghana
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Miller T, Smith H. Establishing partnership with traditional birth attendants for improved maternal and newborn health: a review of factors influencing implementation. BMC Pregnancy Childbirth 2017; 17:365. [PMID: 29052533 PMCID: PMC5649078 DOI: 10.1186/s12884-017-1534-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 08/04/2017] [Indexed: 11/10/2022] Open
Abstract
Background Recent World Health Organization recommendations recognize the important role Traditional Birth Attendants (TBAs) can play in supporting the health of women and newborns. This paper provides an analysis of key factors that affect the implementation of interventions to develop partnerships with TBAs to promote improved access to skilled care at birth. Methods We conducted a secondary analysis of 20 papers identified through two systematic reviews that examined the effectiveness of interventions to find new roles for TBAs on maternal and newborn health outcomes, as well as papers identified through a systematic mapping of the maternal health literature. The Supporting the Use of Research Evidence framework (SURE) guided the thematic analysis to explore the perceptions of various stakeholders and implementation barriers and facilitators, as well as other contextual issues. Results This analysis identified countries that have implemented interventions to support the transition from birth with a TBA to birth with a skilled birth attendant. Drawing on the experiences of these countries, the analysis highlights factors that are important to consider when designing and implementing such interventions. Barriers to implementation included resistance to change in more traditional communities, negative attitudes between TBAs and skilled attendants and TBAs concerns about the financial implications of assuming new roles. Facilitating factors included stakeholder involvement in devising and implementing interventions, knowledge sharing between TBAs and skilled birth attendants, and formalised roles and responsibilities and remuneration for TBAs. Conclusions The implementation barriers identified in this analysis could, if not addressed, prevent or discourage TBAs from carrying out newly defined roles supporting women in pregnancy and childbirth and linking them to the formal health system. This paper also identifies the factors that seem critical to success, which new programmes could consider adopting from the outset. In most cases a multi-faceted approach is needed to prepare TBAs and others for new roles, including the training of TBAs to strengthen their knowledge and skills to enable them to be able to assume new roles, alongside the sensitization of healthcare providers, communities, women and their families. Further research is required to map the transition process and stakeholder experiences in more detailed ways and to provide longer-term monitoring of existing interventions.
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Affiliation(s)
- Tina Miller
- Department of Social Sciences, Oxford Brookes University, Oxford, OX3 0BP, UK.
| | - Helen Smith
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
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Guerra Arias M, Nove A, Michel-Schuldt M, de Bernis L. Current and future availability of and need for human resources for sexual, reproductive, maternal and newborn health in 41 countries in Sub-Saharan Africa. Int J Equity Health 2017; 16:69. [PMID: 28468654 PMCID: PMC5415807 DOI: 10.1186/s12939-017-0569-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The WHO African region, covering the majority of Sub-Saharan Africa, faces the highest rates of maternal and neonatal mortality in the world. This study uses data from the State of the World's Midwifery 2014 survey to cast a spotlight on the WHO African region, highlight the specific characteristics of its sexual, reproductive, maternal and newborn health (SRMNH) workforce and describe and compare countries' different trajectories in terms of meeting the population need for services. METHODS Using data from 41 African countries, this study used a mathematical model to estimate potential met need for SRMNH services, defined as "the percentage of a universal SRMNH package that could potentially be obtained by women and newborns given the composition, competencies and available working time of the SRMNH workforce." The model defined the 46 key interventions included in this universal SRMNH package and allocated them to the available health worker time and skill set in each country to estimate the potential met need. RESULTS Based on the current and projected potential met need in the future, the countries were grouped into three categories: (1) 'making or maintaining progress' (expected to meet more, or the same level, of the need in the future than currently): 14 countries including Ghana, Senegal and South Africa, (2) 'at risk' (currently performing relatively well but expected to deteriorate due to the health workforce not keeping pace with population growth): 6 countries including Gabon, Rwanda and Zambia, and (3) 'low performing' (not performing well and not expected to improve): 21 countries including Burkina Faso, Eritrea and Sierra Leone. CONCLUSION The three groups face different challenges, and policy solutions to increasing met need should be tailored to the specific context of the country. National health workforce accounts should be strengthened so that workforce planning can be evidence-informed.
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Affiliation(s)
| | - Andrea Nove
- Instituto de Cooperación Social Integrare, Barcelona, Spain
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Triyana M. The effects of Indonesia's 'Midwife in the Village' programme 10 years post-launch. Population Studies 2016; 70:365-376. [PMID: 27310221 DOI: 10.1080/00324728.2016.1145728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Data from the Indonesian Family Life Survey (1993-2000) were used to examine whether the effects of the Indonesian 'Midwife in the Village' programme persisted more than 10 years after its implementation. The study followed up earlier studies of the programme's effects by estimating its effects on pregnancy outcomes, using propensity-score matching applied to data collected after the 1997 Asian economic crisis. The results indicate that only the programme's effect on the use of prenatal care services persisted, and that the loss of village midwives during the crisis had no significant effect on pregnancy outcomes.
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Dawson AJ, Nkowane AM, Whelan A. Approaches to improving the contribution of the nursing and midwifery workforce to increasing universal access to primary health care for vulnerable populations: a systematic review. HUMAN RESOURCES FOR HEALTH 2015; 13:97. [PMID: 26684471 PMCID: PMC4683743 DOI: 10.1186/s12960-015-0096-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 12/08/2015] [Indexed: 05/07/2023]
Abstract
BACKGROUND Despite considerable evidence showing the importance of the nursing and midwifery workforce, there are no systematic reviews outlining how these cadres are best supported to provide universal access and reduce health care disparities at the primary health care (PHC) level. This review aims to identify nursing and midwifery policy, staffing, education and training interventions, collaborative efforts and strategies that have improved the quantity, quality and relevance of the nursing and midwifery workforce leading to health improvements for vulnerable populations. METHODS We undertook a structured search of bibliographic databases for peer-reviewed research literature using a focused review question and inclusion/exclusion criteria. The quality of retrieved papers was appraised using standard tools. The characteristics of screened papers were described, and a deductive qualitative content analysis methodology was applied to analyse the interventions and findings of included studies using a conceptual framework. RESULTS Thirty-six papers were included in the review, the majority (25) from high-income countries and nursing settings (32). Eleven papers defined leadership and governance approaches that had impacted upon the health outcomes of disadvantaged groups including policies at the national and state level that had led to an increased supply and coverage of nursing and midwifery staff and scope of practice. Twenty-seven papers outlined human resource management strategies to support the expansion of nurse's and midwives' roles that often involved task shifting and task sharing. These included approaches to managing staffing supply, distribution and skills mix; workloads; supervision; performance management; and remuneration, financial incentives and staffing costs. Education and training activities were described in 14 papers to assist nurses and midwives to perform new or expanded roles and prepare nurses for inclusive practice. This review identified collaboration between nurses and midwives and other health providers and organizations, across sectors, and with communities and individuals that resulted in improved health care and outcomes. CONCLUSIONS The findings of this review confirm the importance of a conceptual framework for understanding and planning leadership and governance approaches, management strategies and collaboration and education and training efforts to scale up and support nurses and midwives in existing or expanded roles to improve access to PHC for vulnerable populations.
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Affiliation(s)
- A J Dawson
- Faculty of Health, University of Technology Sydney (UTS) World Health Organization Collaborating Centre for Nursing, Midwifery and Health Development, Jones Street, Sydney, NSW, Australia.
| | - A M Nkowane
- Health Workforce Department, World Health Organization, Geneva, Switzerland.
| | - A Whelan
- Faculty of Health, University of Technology Sydney (UTS) World Health Organization Collaborating Centre for Nursing, Midwifery and Health Development, Jones Street, Sydney, NSW, Australia.
- University of New South Wales (UNSW), Sydney, Australia.
- Sydney Local Health District, Sydney, NSW, Australia.
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YAZDKHASTI M, POURREZA A, PIRAK A, ABDI F. Unintended Pregnancy and Its Adverse Social and Economic Consequences on Health System: A Narrative Review Article. IRANIAN JOURNAL OF PUBLIC HEALTH 2015; 44:12-21. [PMID: 26060771 PMCID: PMC4449999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 11/23/2014] [Indexed: 11/28/2022]
Abstract
Unintended pregnancy is among the most troubling public health problems and a major reproductive health issue worldwide imposing appreciable socioeconomic burden on individuals and society. Governments generally plan to control growth of births (especially wanted births as well as orphans and illegitimate births) imposing extra burden on public funding of the governments which inevitably affects economic efficiency and leads to economic slowdown, too. The present narrative review focuses on socioeconomic impacts of unintended pregnancy from the health system perspective. Follow of Computerized searches of Academic, 53 scientific journals were found in various databases including PubMed, EMBASE, ISI, Iranian databases, IPPE, UNFPA (1985-2013). Original articles, review articles, published books about the purpose of the paper were used. During this search, 20 studies were found which met the inclusion criteria. Unintended pregnancy is one of the most critical challenges facing the public health system that imposes substantial financial and social costs on society. On the other hand, affecting fertility indicators, it causes reduced quality of life and workforce efficiency. Therefore lowering the incidence of intended pregnancies correlates with elevating economic growth, socio-economic development and promoting public health. Regarding recent policy changes in Iran on family planning programs and adopting a new approach in increasing population may place the country at a higher risk of increasing the rate of unintended pregnancy. Hence, all governmental plans and initiatives of public policy must be regulated intelligently and logically aiming to make saving in public spending and reduce healthcare cost inflation.
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Affiliation(s)
- Mansureh YAZDKHASTI
- 1. Dept. of Reproductive Health, School of Nursing & Midwifery, Tehran University, Tehran, Iran
| | - Abolghasem POURREZA
- 2. Dept. of Health Management & Economics, School of Public Health, Tehran University, Tehran, Iran
| | - Arezoo PIRAK
- 1. Dept. of Reproductive Health, School of Nursing & Midwifery, Tehran University, Tehran, Iran
| | - Fatemeh ABDI
- 3. Dept. of Reproductive Health, School of Nursing & Midwifery, Shahid Beheshti University, Tehran, Iran
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Feyissa TR, Genemo GA. Determinants of institutional delivery among childbearing age women in Western Ethiopia, 2013: unmatched case control study. PLoS One 2014; 9:e97194. [PMID: 24810609 PMCID: PMC4014613 DOI: 10.1371/journal.pone.0097194] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 04/16/2014] [Indexed: 12/02/2022] Open
Abstract
Background Place of delivery is a crucial factor which affects the health and wellbeing of the mother and newborn. Institutional delivery helps the women to access skilled assistance, drugs, equipment, and referral transport. Even though 34% of pregnant women received at least one antenatal care from a skilled provider in Ethiopia by 2013, institutional delivery was 10%. The main objective of the study was to assess determinants of institutional delivery in Western Ethiopia. Methods Retrospective unmatched case control study design was used to assess determinants of institutional delivery in Western Ethiopia from September to October 2013. A total of 320 respondents from six districts of East Wollega zone, West Ethiopia were included. Data were collected using pretested and structured questionnaires. Data were entered and cleaned by Epi-info then exported and analyzed using SPSS software. Statistical significance was determined through a 95% confidence level. Results Education [Adjusted Odds Ratio (AOR) (95% Confidence Interval (CI)) = 2.754(1.510–8.911)], family size [AOR (95% CI) = .454(.209–.984)], residence [AOR (95% CI) = 3.822 (1.766–8.272)] were important predictors of place of delivery. Four or more antenatal care [(ANC) (AOR (95% CI) = 2.914(1.105–7.682)], birth order [(AOR (95% CI) = .136(.054–.344), age at last delivery [(AOR (95% CI) = 9.995(2.101–47.556)], birth preparedness [AOR (95% CI) = 6.957(2.422–19.987)], duration of labour [AOR (95% CI) = 3.541(1.732–7.239)] were significantly associated with institutional delivery. Moreover service related factors such as distance from health institutions [AOR (95% CI) = .665(.173–.954)], respondents’ awareness of skill of health care professionals [AOR (95% CI) = 2.454 (1.663–6.255)], mode of transportations [AOR (95% CI) = .258(.122–.549)] were significantly associated with institutional delivery. Conclusions and Recommendations Policy makers, health service organizations, community leaders and other concerned bodies have to consider the predictors of institutional delivery like education, birth order, antenatal care utilization and residence to improve institutional delivery in the area.
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Affiliation(s)
- Tesfaye Regassa Feyissa
- College of medical and health sciences, Wollega University, Nekemte, Oromia, Ethiopia
- * E-mail:
| | - Gebi Agero Genemo
- School of Health Sciences, Adama University, Asella, Oromia, Ethiopia
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Weaver EH, Frankenberg E, Fried BJ, Thomas D, Wheeler SB, Paul JE. Effect of village midwife program on contraceptive prevalence and method choice in Indonesia. Stud Fam Plann 2013; 44:389-409. [PMID: 24323659 DOI: 10.1111/j.1728-4465.2013.00366.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Indonesia established its Village Midwife Program in 1989 to combat high rates of maternal mortality. The program's goals were to address gaps in access to reproductive health care for rural women, increase access to and use of family planning services, and broaden the mix of available contraceptive methods. In this study, we use longitudinal data from the Indonesia Family Life Survey to examine the program's effect on contraceptive practice. We find that the program did not affect overall contraceptive prevalence but did affect method choice. Over time, for women using contraceptives, midwives were associated with increased odds of injectable contraceptive use and decreased odds of oral contraceptive and implant use. Although the Indonesian government had hoped that the Village Midwife Program would channel women into using longer-lasting methods, the women's "switching behavior" indicates that the program succeeded in providing additional outlets for and promoting the use of injectable contraceptives.
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Affiliation(s)
- Emily H Weaver
- Fogarty Global Health Fellow, School of Medicine, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Campus Box 7030, Chapel Hill, NC, 27599.
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Increasing the use of skilled health personnel where traditional birth attendants were providers of childbirth care: a systematic review. PLoS One 2012; 7:e47946. [PMID: 23110138 PMCID: PMC3480459 DOI: 10.1371/journal.pone.0047946] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 09/18/2012] [Indexed: 12/03/2022] Open
Abstract
Background Improved access to skilled health personnel for childbirth is a priority strategy to improve maternal health. This study investigates interventions to achieve this where traditional birth attendants were providers of childbirth care and asks what has been done and what has worked? Methods and Findings We systematically reviewed published and unpublished literature, searching 26 databases and contacting experts to find relevant studies. We included references from all time periods and locations. 132 items from 41 countries met our inclusion criteria and are included in an inventory; six were intervention evaluations of high or moderate quality which we further analysed. Four studies report on interventions to deploy midwives closer to communities: two studies in Indonesia reported an increase in use of skilled health personnel; another Indonesian study showed increased uptake of caesarean sections as midwives per population increased; one study in Bangladesh reported decreased risk of maternal death. Two studies report on interventions to address financial barriers: one in Bangladesh reported an increase in use of skilled health personnel where financial barriers for users were addressed and incentives were given to skilled care providers; another in Peru reported that use of emergency obstetric care increased by subsidies for preventive and maternity care, but not by improved quality of care. Conclusions The interventions had positive outcomes for relevant maternal health indicators. However, three of the studies evaluate the village midwife programme in Indonesia, which limits the generalizability of conclusions. Most studies report on a main intervention, despite other activities, such as community mobilization or partnerships with traditional birth attendants. Many authors note that multiple factors including distance, transport, family preferences/support also need to be addressed. Case studies of interventions in the inventory illustrate how different countries attempted to address these complexities. Few high quality studies that measure effectiveness of interventions exist.
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Doctor HV. Intergenerational differences in antenatal care and supervised deliveries in Nigeria. Health Place 2010; 17:480-9. [PMID: 21195014 DOI: 10.1016/j.healthplace.2010.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 12/02/2010] [Accepted: 12/03/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To assess whether age cohort influences the likelihood of receiving antenatal care (ANC) and having a supervised delivery, before and after adjusting for other factors. DESIGN Using data from the 2008 Nigeria Demographic and Health Survey, we grouped women into three distinct cohorts based on their year of birth: the young (1984-1993), the middle (1974-1983) and the older (1959-1973) cohorts. We applied multilevel logistic regression methods to assess the influence of age cohort on receiving ANC and having a supervised delivery among women (n=18,028) whose most recent birth occurred anytime in the five years preceding the survey. RESULTS We identified belonging to the youngest age cohort, rural residence, lack of schooling, higher parity, residence in northern region and poor economic status as determinants of low uptake of ANC and supervised deliveries. CONCLUSION Urgent efforts are needed in Nigeria to ensure that young women in particular receive ANC and have supervised deliveries. An agenda promoting a combination of individuals campaigning for change (particularly in northern Nigeria), communities raising awareness among men and women, and governmental and nongovernmental organizations working together to find practical solutions is an indispensable aim for saving the lives of many women and children who are at risk of dying of maternal and child-related diseases.
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Affiliation(s)
- Henry V Doctor
- Columbia University, Mailman School of Public Health, Department of Population and Family Health, New York, NY 10032, USA.
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Allendorf K. The Quality of Family Relationships and Use of Maternal Health-care Services in India. Stud Fam Plann 2010; 41:263-76. [DOI: 10.1111/j.1728-4465.2010.00252.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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