Factors affecting utilization of skilled maternal care in Northwest Ethiopia: a multilevel analysis

Pattern of admission, outcome and predictors of trauma patients visiting the surgical emergency department in comprehensive specialized hospital: a retrospective follow-up study

Background

Traumatic injuries represent a huge burden in the developing world, and a significant proportion has found in low-income and middle-income countries. However, the pattern, outcome and factors of injury varies from setup to setup and is less studied in public health problems.

Objective

To assess pattern of admission, outcome and its predictors among trauma patients visiting the surgical emergency department in a comprehensive specialized hospital.

Methods

A retrospective follow-up study was conducted, and data were taken from the medical records of patients from 2019 to 2021. A simple random sampling technique was used to get a sample size of 386 from injured patient charts. Data were entered into Epi-Data version 4.6 software and exported to STATA version 14.1 for analysis. The dependent variable was injured patient's outcome, which could be died or not died. The independent variables with P value less than 0.25 in the bi-variable regression analysis were considered for the multivariable regression. Adjusted odds ratio (AOR) with the 95% CI were used to declare statistical significance.

Result

About 13.99% of injured patients with (95% CI: 10, 17) had died during the study period. The leading cause of injury was assault (62.44%) followed by road traffic accidents (26.17%). Severe Glasgow Coma Scale (AOR 6.6; 95% CI: 2.6-16.4), length of hospital stay more than or equal to 7 days (AOR=2.8; 95% CI: 1.2-6.2), time of arrival in between 1 and 24 h (AOR=0.15; 95% CI: 0.06-0.37), and upper trunk injury (AOR=6.3; 95% CI: 1.3-28.5) were significantly associated with mortality.

Conclusion and recommendation

Mortality after traumatic injury was considerably high. Severe Glasgow Coma Scale, Length of hospital stay more than or equal to 7 days, time of arrival in between 1 and 24 h, and upper trunk injury were the associated factors for mortality. Priority should be given for injured patients with decreased levels of consciousness and upper trunk injury. The establishment of organized pre-hospital emergency services and provision of timely arrival is recommended. The authors recommend prospective follow-up study.

Utilization of Antenatal Care and Skilled Birth Delivery Services in Sub-Saharan Africa: A Systematic Scoping Review

Daily, the number of women who die around the world reaches an average of 800; these deaths are a result of obstetric complications in pregnancy and childbirth, and 99% of these deaths occur in low- and middle-income countries. This review probes the use of antenatal care (ANC) and skilled birth delivery (SBD) services in sub-Saharan Africa (SSA) and highlights research gaps using Arksey and O'Malley's methodological approach. The screening of abstracts and full text was carried out by two independent authors who ensured the eligibility of data extraction from the included articles. An exploration of the data was undertaken with descriptive analyses. In total, 350 potentially eligible articles were screened, and 137 studies were included for data extraction and analysis. From the 137 included studies, the majority were from Ethiopia (n = 40, 29.2%), followed by Nigeria (n = 30, 21.9%). Most of the studies were published between 2019 and 2023 (n = 84, 61%). Significant trends and challenges with ANC and SBD services emerged from the studies. It is revealed that there are wide gaps in the utilization of ANC and SBD services. Policy attention, intervention strategies to improve access, resources, rural-urban disparity, and women's literacy are recommended to improve the utilization of ANC and SBD services in SSA countries.

Spatial patterns and determinants of low utilization of delivery care service and postnatal check-up within 2 months following birth in Ethiopia: Bivariate analysis

BACKGROUND

Home delivery is a nonclinical childbirth practice that takes place in one's home with or without traditional birth attendants and postnatal care is the care given to the mother and her newborn baby; according to world health organization (WHO), the postnatal phase, begins one hour after birth and lasts six weeks (42 days). This paper aimed to study the spatial pattern and determinant factors of low utilization of delivery care (DC) services and postnatal check-up (PNC) after live births in Ethiopia.

METHODS

This study used the 2016 Ethiopian Demographic and Health Survey data as a source. A total weighted samples of 11023 women-children pairs were included. The bivariate binary logistic regression analyses with spatial effect were modeled using SAS version 9.4 and ArcGIS version 10.8 was used for mapping.

RESULTS

The spatial distribution of low utilization of delivery care service and postnatal check-up were significantly clustered in Ethiopia (Moran's I statistic 0.378, P-value < 0.001 and 0.177, P-value < 0.001 respectively). Among 11023 children-women pair, the prevalence of home delivery and no postnatal check-up within two months following birth were 72.6% and 91.4% respectively. The Liben, Borena, Guji, Bale, Dolo and Zone 2 were predicted to have high prevalence of home delivery and part of Afder, Shabelle, Korahe, Dolo and Zone 2 were high risk areas of no postnatal checkup.

CONCLUSION AND RECOMMENDATIONS

Lack of occupation, region, large family size, higher birth order, low utilization of antenatal care visit, unable to access mass media, big problem of health facility distance and the spatial variable were found to be jointly significant predictors of low utilization of DC and PNC in Ethiopia. Whereas older age, being reside in rural area and low wealth status affects delivery care service utilization. We suggest health providers, policy makers and stakeholders consider those variables with priority given to Liben, Borena, Guji, Bale, Dolo, Zone 2, Afder, Shabelle and Korahe, where home delivery and no PNC were predicted relatively high. We also recommend researchers to conduct further studies using latest survey data set.

Supply-side factors influencing demand for facility-based delivery in Tanzania: a multilevel analysis

BACKGROUND

Improving access to facility-based delivery care has the potential to reduce maternal and newborn deaths across settings. Yet, the access to a health facility for childbirth remains low especially in low-income settings. To inform evidence-based interventions, more evidence is needed especially accounting for demand- and supply-side factors influencing access to facility-based delivery care. We aimed to fill this knowledge gap using data from Tanzania.

METHODS

We used data from a cross-sectional survey (conducted in January 2012) of 150 health facilities, 1494 patients and 2846 households with women who had given births in the last 12 months before the survey across 11 districts in three regions in Tanzania. The main outcome was the place of delivery (giving birth in a health facility or otherwise), while explanatory variables were measured at the individual woman and facility level. Given the hierarchical structure of the data and variance in demand across facilities, we used a multilevel mixed-effect logistic regression to explore the determinants of facility-based delivery care.

RESULTS

Eighty-six percent of 2846 women gave birth in a health facility. Demand for facility-based delivery care was influenced more by demand-side factors (76%) than supply-side factors (24%). On demand-side factors, facility births were more common among women who were educated, Muslim, wealthier, with their first childbirth, and those who had at least four antenatal care visits. On supply-side factors, facility births were more common in facilities offering outreach services, longer consultation times and higher interpersonal quality. In contrast, facilities with longer average waiting times, longer travel times and higher chances of charging delivery fees had few facility births.

CONCLUSIONS

Policy responses should aim for strategies to improve demand like health education to raise awareness towards care seeking among less educated groups and those with higher parity, reduce financial barriers to access (including time costs to reach and access care), and policy interventions to enhance interpersonal quality in service provision.

Missed Opportunity of Antenatal Care Services Utilization and Associated Factors among Reproductive Age Women in Eastern Hararghe Zone, Eastern Ethiopia: Mixed Methods Study

Background

Despite the enormous advantages of early pregnancy-related problem diagnosis and therapy during prenatal care visits, not all pregnant women begin antenatal care at the proper time. Thus, this study aims to identify factors associated with missed opportunities for antenatal care service utilization among reproductive-age women in Eastern Ethiopia.

Methods

A mixed methods study design (quantitative and qualitative) was conducted in Grawa, Meta, and Haramaya woredas from September 5 to December 5, 2019. The quantitative data were analyzed using SPSS version 25. A multivariable logistic regression analysis model was used to identify the predictors. Statistical software programs based on ATLAS.ti version 8.2 was were used to conduct the thematic analysis of the qualitative data.

Results

Overall, missed opportunities for antenatal care were 15.4% of 95% (12.1, 19.1%). Factors such as maternal age being 15-24 (AOR = 6.9, 95% CI: 2.89-8.81); having a college education (AOR = 0.02, 95% CI: 0.001, 0.42), elementary (AOR = 0.05, 95% CI: 0.002, 0.98), and secondary education (AOR = 0.04, 95% CI: 0.001, 0.88); having five and more parity (AOR = 0.08, 95% CI: 0.01, 0.75); three visits (AOR = 0.10, 95% CI: 0.02, 0.71); those in the first trimester (AOR = 0.02, 95% CI: 0.001, 0.35) and the second trimester (AOR = 0.01, 95% CI: 0.001, 0.26); and get information from a health facility (AOR =0.09, 95% CI: 0.01, 0.67) and traditional birth attendance (AOR = 0.02, 95% CI: 0.001, 0.74) were factors statistically associated with outcome variables.

Conclusions

According to this report, relatively high proportions of pregnant women experienced missed opportunities in antenatal care follow-up. Factors such as maternal age, education, parity, frequency, timing, and media access were statistically significantly correlated with missed antenatal care follow-up. Therefore, all stakeholders should emphasize advocating for and enhancing the benefits of antenatal care; this in turn plays a crucial role in increasing the follow-up of clients for these crucial services. Moreover, health policy implementers need to coordinate their tracking of pregnant women who missed their antenatal care session.

Individual, Community, and Health Facility Predictors of Postnatal Care Utilization in Rural Tanzania: A Multilevel Analysis

INTRODUCTION

Postnatal care (PNC) is an underused service in the continuum of care for mothers and infants in sub-Saharan Africa. There is little evidence on health facility characteristics that influence PNC utilization. Understanding PNC use in the context of individual, community, and health facility characteristics may help in the development of programs for increased use.

METHODS

We analyzed data from 4,353 women with recent births in Kigoma Region, Tanzania, and their use of PNC (defined as at least 1 checkup in a health facility in the region within 42 days of delivery). We used a mixed-effects multilevel logistic regression analysis to explain PNC use while accounting for household, individual, and community characteristics from a regionwide population-based reproductive health survey and for distance to and adequacy of proximal health facilities from a health facility assessment.

RESULTS

PNC utilization rate was low (15.9%). Women had significantly greater odds of PNC if they had a high level of decision-making autonomy (adjusted odds ratio [aOR]: 1.56; 95% confidence interval [CI]=1.11, 2.17); had a companion at birth (aOR: 1.57; 95% CI=1.19, 2.07); had cesarean delivery (aOR: 2.27; 95% CI=1.47, 3.48); resided in Kasulu district (aOR: 3.28; 95% CI=1.94, 5.52); or resided in a community that had at least 1 adequate health facility within 5 km (aOR: 2.15; 95% CI=1.06, 3.88).

CONCLUSION

Women's decision-making autonomy and presence of companionship at birth, as well as proximity to a health facility with adequate infrastructure, equipment, and workforce, were associated with increased PNC use. More efforts toward advocating for the health benefits of PNC using multiple channels and increasing quality of care in health facilities, including companionship at birth, can increase utilization rates.

Women's utilisation of quality antenatal care, intrapartum care and postnatal care services in Ethiopia: a population-based study using the demographic and health survey data

OBJECTIVE

This study sought to investigate the level and determinants of receiving quality antenatal care (ANC), intrapartum care, and postnatal care (PNC) services by women in Ethiopia. The quality of care a woman receives during ANC, intrapartum care, and PNC services affects the health of the woman and her child and her likelihood of seeking care in the future.

METHODS

Data from the nationally representative Ethiopia Mini Demographic and Health Survey 2019 were analysed for 5,527 mothers who gave birth within five years preceding the survey. We defined quality ANC as having: blood pressure measurement, urine and blood tests, informed of danger signs, iron supplementation, and nutritional counselling during ANC services; quality intrapartum care as having: a health facility birth, skilled birth assistance, and a newborn put to the breast within one hour of birth during intrapartum care services; and quality PNC as having: PNC within two days; cord examination; temperature measurement, and counselling on danger signs and breastfeeding of the newborn; and healthcare provider's observation of breastfeeding during PNC services. We used multilevel mixed-effects logistic regression analyses specifying three-level models: a woman/household, a cluster, and an administrative region to determine predictors of each care quality. The analyses employed sampling weights and were adjusted for sampling design.

RESULTS

Thirty-six percent (n = 1,048), 43% (n = 1,485), and 21% (n = 374) women received quality ANC, intrapartum care and PNC services, respectively. Private healthcare facilities provided higher-quality ANC and PNC but poor-quality intrapartum care, compared to public health facilities. Having four or more ANC visits, commencing ANC during the first trimester, and higher women's education levels and household wealth indices were positive predictors of quality ANC use. Government health posts were less likely to provide quality ANC. Wealthier, urban-residing women with education and four or more ANC contacts were more likely to receive quality intrapartum care. Women who received quality ANC and skilled birth assistance were more likely to receive quality PNC. Teenage mothers were more likely to receive quality intrapartum care, but were less likely to receive quality PNC than mothers aged 20-49.

CONCLUSIONS

We recommend standardizing the contents of ANC provided in all healthcare facilities; and promoting early and four or more ANC contacts, effectiveness, sensitivity and vigilance of care provided to teenage mothers, and women's education and economic empowerment.

Trend analysis of multi-level determinants of maternal and newborn postnatal care utilization in Pakistan from 2006 to 2018: Evidence from Pakistan Demographic and Health Surveys

BACKGROUND

Postnatal care (PNC) is crucial for maternal and newborn health. Healthcare-seeking practices within the postpartum period help healthcare providers in early detection of complications related to childbirth and post-delivery period. This study aims to investigate trends of PNC utilization from 2006 to 2018, and to explore the effects of multi-level determinants of both maternal and newborn PNC in Pakistan.

METHODS

Secondary data analysis of the last three waves of the nationally representative Pakistan Demographic and Health Surveys (PDHSs) was conducted Analysis was limited to all those women who had delivered a child during the last 5 years preceding each wave of PDHS Bivariate and multivariate logistic regression was applied to determine the association of maternal and newborn PNC utilization with multi-level determinants at individual, community, and institutional levels.

RESULTS

In Pakistan, an upward linear trend in maternal PNC utilization was found, with an increase from 43.5 to 63.6% from 2006 to 2018. However, a non-linear trend was observed in newborn PNC utilization, with an upsurge from 20.6 to 50.5% from 2006 to 2013, nonetheless a decrease of 30.7% in 2018. Furthermore, the results highlighted that the likelihood of maternal and newborn PNC utilization was higher amongst older age women, who completed some years of schooling, were employed, had decision-making and emotional autonomy, had caesarean sections, and delivered at health facilities by skilled birth attendants. Multivariate analysis also revealed higher odds for women of older age, who had decision-making and emotional autonomy, and had caesarean section deliveries over the period of 2006-2018 for both maternal and newborn PNC utilization. Further, higher odds for maternal PNC utilization were found with parity and size of newborn, while less for ANC attendance and available means of transportation. Furthermore, increased odds were recorded for newborn PNC utilization with the number of children, ANC attendance, gender of child and mass media exposure from 2006 to 18.

CONCLUSION

A difference in maternal and newborn PNC utilization was found in Pakistan, attributed to multiple individual (socio-demographic and obstetrics), community, and institutional level determinants. Overall, findings suggest the need to promote the benefits of PNC for early diagnosis of postpartum complications and to plan effective public health interventions to enhance women's access to healthcare facilities and skilled birth assistance to save mothers' and newborns' lives.

Comparison of inequality in utilization of maternal healthcare services between Bangladesh and Pakistan: evidence from the demographic health survey 2017-2018

BACKGROUND

Inequality in maternal health has remained a challenge in many low-income countries, like Bangladesh and Pakistan. The study examines within-country and between-country inequality in utilization of maternal healthcare services for Bangladesh and Pakistan.

METHODS

The study used the latest Demographic Health Surveys (DHS, 2017-2018) datasets of Bangladesh and Pakistan for women aged 15-49 years who had given at least one live birth in three years preceding the survey. Equity strata were identified from the literature and conformed by binary logistic regressions. For ordered equity strata with more than two categories, the relative concentration index (RCI), absolute concentration index (ACI) and the slope index of inequality (SII) were calculated to measure inequalities in the utilization of four maternal healthcare services. For two-categories equity strata, rate ratio (RR), and rate difference (RD) were calculated. Concentration curves and equiplots were constructed to visually demonstrate inequality in maternal healthcare services.

RESULTS

In Bangladesh, there was greater inequality in skilled birth attendance (SBA) based on wealth (RCI: 0.424, ACI: 0.423, and SII: 0.612), women's education (RCI: 0.380, ACI: 0.379 and SII: 0.591), husband's education (RCI: 0.375, ACI: 0.373 and SII: 0.554) and birth order (RCI: - 0.242, ACI: - 0.241, and SII: -0.393). According to RCI, ACI, and SII, there was inequality in Pakistan for at least four ANC visits by the skilled provider based on wealth (RCI: 0.516, ACI: 0.516 and SII: 0.738), women's education (RCI: 0.470, ACI: 0.470 and SII: 0.757), and husband's education (RCI: 0.380, ACI: 0.379 and SII: 0.572). For Bangladesh, the RR (1.422) and RD (0.201) imply more significant urban-rural inequality in SBA. In Pakistan, urban-rural inequality was greater for at least four ANC visits by the skilled provider (RR: 1.650 and RD 0.279).

CONCLUSION

Inequality in maternal healthcare is greater among the underprivileged group in Pakistan than in Bangladesh. In Bangladesh, the SBA is the most inequitable maternal healthcare, while for Pakistan it is at least four ANC visits by the skilled provider. Customized policies based on country context would be more effective in bridging the gap between the privileged and underprivileged groups.

Determinants of maternal healthcare utilisation among pregnant women in Southern Ethiopia: a multi-level analysis

BACKGROUND

Despite efforts to make maternal health care services available in rural Ethiopia, utilisation status remains low. Therefore, this study aimed to assess maternal health care services' status and determinants in rural Ethiopia.

METHODS

The study used quasi-experimental pre- and post-comparison baseline data. A pretested, semi-structured, interviewer-administered questionnaire was used to collect data. A multilevel, mixed-effects logistic regression was used to identify individual and communal level factors associated with utilisation of antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC). The adjusted odds ratio (AOR) and corresponding 95% confidence intervals (CI) were estimated with a p-value of less than 0.05, indicating statistical significance.

RESULTS

Seven hundred and twenty-seven pregnant women participated, with a response rate of 99.3%. Four hundred and sixty-one (63.4%) of the women visited ANC services, while 46.5% (CI: 42-50%) of births were attended by SBA, and 33.4% (CI: 30-36%) had received PNC. Women who reported that their pregnancy was planned (aOR = 3.9; 95% CI: 1.8-8.3) and were aware of pregnancy danger signs (aOR = 6.8; 95% CI: 3.8-12) had a higher likelihood of attending ANC services. Among the cluster-level factors, women who lived in lowlands (aOR = 4.1; 95% CI: 1.1-14) and had easy access to transportation (aOR = 1.9; 95% CI: 1.1-3.7) had higher odds of visiting ANC services. Moreover, women who were employed (aOR = 3.1; 95% CI: 1.3-7.3) and attended ANC (aOR = 3.3; 95% CI: 1.8-5.9) were more likely to have SBA at delivery. The likelihood of being attended by SBA during delivery was positively correlated with shorter travel distances (aOR = 2.9; 95% CI: 1.4-5.8) and ease of access to transportation (aOR = 10; 95% CI: 3.6-29) to the closest healthcare facilities. Being a midland resident (aOR = 4.7; 95% CI: 1.7-13) and having SBA during delivery (aOR = 2.1; 95% CI: 1.2-3.50) increased the likelihood of attending PNC service.

CONCLUSIONS

Overall, maternal health service utilisation is low in the study area compared with the recommended standards. Women's educational status, awareness of danger signs, and pregnancy planning from individual-level factors and being a lowland resident, short travel distance to health facilities from the cluster-level factors play a crucial role in utilising maternal health care services. Working on women's empowerment, promotion of contraceptive methods to avoid unintended pregnancy, and improving access to health care services, particularly in highland areas, are recommended to improve maternal health service utilisation.

Determinants of continuum of care for maternal, newborn, and child health services in Ethiopia: Analysis of the modified composite coverage index using a quantile regression approach

Maternal and child mortality remain unacceptably high in the Sustainable Development Goals era. Continuum of care has become a key strategy for improving the health of mothers and newborns. Previous research on the continuum of care in Ethiopia is often limited to maternal health services. Maternal and child health services are inseparably linked, and an integrated approach to care is essential. This study assessed the continuum of maternal, newborn, and child health care and associated factors in Ethiopia. The analysis was based on the 2016 Ethiopian Demographic and Health Survey data. We restricted our analysis to women with their most recent children-alive and living with their mother- aged 12-23 months at the time of the survey (n  =  1891). The modified composite coverage index, constructed from twelve maternal and child health services, was calculated as an indicator of the continuum of care. Bivariable and multivariable quantile regression were used to analyse the relationship between the predictors and specific quantiles of the composite coverage index. The effect of each variable was examined at the 10th, 25th, 50th, 75th, and 95th quantiles. The results showed that the average composite coverage index value was 39%. The overall completion rate of the continuum of care was low (2%). Four % of the women did not receive any of the services along the continuum of care. Postnatal care for newborns had the lowest coverage (12%). This study provides evidence that factors such as the educational status of women, region, residence, socio-economic status, perceived distance to a health facility, pregnancy intention, mode of delivery, parity, and early antenatal care initiation influence the continuum of care differently across levels of the composite coverage index. The findings call for integrated and targeted strategies that aim to improve the continuum of care considering the determinants.

Utilization of optimal antenatal care, institutional delivery, and associated factors in Northwest Ethiopia

Optimal antenatal care visits (ANC4+) and institutional delivery are essentials to save lives of the women and the baby during pregnancy and delivery. Though focused antenatal care visits and institutional delivery is recommended by World Health Organization, Ethiopia has sub-optimal antenatal care and lagged facility delivery. A community-based cross-sectional study was conducted among 811 lactating women in Northwest Ethiopia. Multivariable logistic regression analysis was performed using 95% confidence level and p < 0.05. The prevalence of optimal antenatal care visits and institutional delivery were 39.6% (95%CI: 36.2-43) and 62.6% (95%CI: 59.2-66), respectively. Maternal education (AOR = 2.05; 95%CI: 1.14, 3.69), home visiting by health extension workers (AOR = 1.57; 95%CI: 1.01, 2.29), and early antenatal care booking (AOR = 11.92; 95%CI: 8.22, 17.31) were significant predictors of optimal antenatal care. Exposure to mass media (AOR = 1.65; 95% CI: 1.02, 2.65); intended pregnancy(AOR = 1.68; 95%CI:1.12, 3.63); parity of one (AO = 3.46; 95% CI: 1.73, 6.89); 1-3 antenatal care visits (AOR = 2.17; 95% CI: 1.29, 3.63); and ANC4 + (AOR = 3.57; 95% CI: 2.07, 6.14); history of pregnancy-related complications(AOR = 1.63; 95%CI: 1.04, 2.57), and access to transportation to reach a health facility(AOR = 1.58; 95%CI: 1.00, 2.45) were significant predictors of institutional delivery. Addressing the modifiable factors identified in this study could improve optimal antenatal care visit and institutional delivery.

Sociodemographic and Maternal Determinants of Postnatal Care Utilization: A Cross-Sectional Study

Introduction

Postnatal care (PNC) is critical for the newborn and the mother, as it offers the opportunity to examine the mother and child to ensure early and timely intervention of any obstetric anomalies that might have gone unnoticed during delivery. However, there is a lack of data on PNC utilization and associated determinants in Ghana. Meanwhile, it is suspected that the PNC service should be more patronized by mothers, particularly within the first 2 days after delivery; therefore, investigating PNC utilization and associated factors could inform policies to enhance PNC uptake.

Objective

The objective is to determine the level of utilization of PNC service and associated factors in the Savannah region of Ghana.

Methods

The study used a facility-based analytical cross-sectional study design. The study was carried out in 311 postnatal mothers using consecutive sampling. Data collection was carried out using a questionnaire. Univariate and multiple logistic regression was performed to establish the determinants of PNC. Variables/variable categories with P < .05 were significantly associated with PNC. The significance level is anchored at P < .05.

Results

The study showed that almost all respondents (98.7%) have heard about PNC services through health workers (39.7%), media (13.0%), and friends and relatives (47.2%). Most of the respondents (88.7%) have used PNC services within 48 h. Mothers aged 25-39 years were about seven times more likely to utilize PNC compared to those who were less than 25 years old (AOR [adjusted odds ratio] = 7.41, 95% CI [confidence interval]: 1.98-7.71); mothers with high school education (SHS) and above were also approximately four times more likely to use PNC compared to those who had no formal education (AOR = 3.65, 95% CI 1.97-13.66). In the same vein, married mothers were 10 times more likely to use PNC compared to those who are single mothers (AOR = 10.34, 95% CI: 3.69-28.97), whereas mothers who had at least four antenatal care (ANC) visits during pregnancy were approximately seven times more likely to use PNC compared to those who had less than four ANC visits (AOR = 6.92, 95% CI: 1.46-32.78). Reasons for not attending PNC include waiting time (40.5%), health workers' attitude (32.4%), being attended by a student (16.2%), being busy (27.0%), inadequate information on PNC (24.3%), and no family support (18.9%).

Conclusion

All mothers knew about the PNC services, with a higher proportion patronizing the services. The increasing age, the level of mothers, marital status, and participation in ANC were significant determinants of the use of PNC. More education during ANC on the importance of PNC service is required to achieve universal coverage of PNC.

Challenges in antenatal care utilization in Kandahar, Afghanistan: A cross-sectional analytical study

BACKGROUND

Quality antenatal care (ANC) is one of the four pillars of safe motherhood initiatives and improves the survival and health of mother and neonate. The main objective of this study was to assess the barriers in the utilization of ANC services in Kandahar, Afghanistan.

METHODS

This was a cross-sectional analytical study conducted over one year from December 2018-November 2019. Data were analyzed by descriptive statistics, Chi squared, and binary logistic regression.

RESULTS

A total of 1524 women were recruited in this study with mean age of 30.3 years. Of these women, 848 (55.6%) were rural dwellers, 1450/1510 (96.0%) were illiterate, 438/608 (72.0%) belonged to low-income families, 1112/1508 (73.7%) lived in joint families, 1420/1484 (95.7%) lived in a house of >10 inhabitants, while 388/1494 (26.0%) had attended had at least one ANC visit during their last pregnancy. On univariate analysis, the main barriers in the utilization of ANC services were living in rural areas, being illiterate, having lower socio-economic status, remoteness of the health facility from home, bad behavior of clinic personnel, and unplanned pregnancy. Only lower socio-economic status and bad behavior of clinic personnel were independent explanatory variables in the regression model.

CONCLUSIONS

Utilization of ANC services is inadequate in Kandahar province. Improving clinic staff professional behavior and status of women by expanding educational opportunities, and enhancing community awareness of the value of ANC are recommended.

Determining factors associated with the prevalence of knowledge, attitude, and practice in seeking skilled maternal healthcare services among women in a remote area of Gesha district

Background

Skilled health care is essential for the mother's and newborn's health and well-being during pregnancy, labor, and the postpartum period. This study aimed to analyze women's knowledge, attitudes, and practices while requesting competent assistance for maternity healthcare in Gesha District, Southwest Region of Ethiopia.

Methods

A community-based cross-sectional study design was conducted from September 20, 2021 to October 19, 2021. A total of 424 mothers participated in this study and a systematic sampling technique was used to select the respondents. The data were collected using a pretested and structured questionnaire. Statistical software SPSS-20 and R-4.1.2 were used to enter and analyze the data respectively. The factors associated with the prevalence of Knowledge, Attitude, and Practice in seeking Skilled Maternal Healthcare Services were identified using descriptive analysis and a binary logistic regression model.

Results

This study result revealed that the overall proportions of good knowledge, positive attitude, and good practice in seeking skilled maternal health care services were 39.15%, 37.5%, and 34.67% respectively. Estimated odds of having knowledge, attitude, and practice were as follows: for having age between 20–24 years at first pregnancy 1.859, 1.86, and 1.799; having a plan for pregnancy 2.74,2.315 and 2.579; mothers attended elementary education 2.337, 2.565 and 3.312; having maternal age 20–24 years 4.336,4.989 and 5.870; maternal age 25–29 years 2.917, 3.794 and 4.017; maternal age 35–49 years 2.837, 2.991 and 3.412; having husbands who had attended elementary education level 2.736, 2.542 and 2.134; secondary and above education 3.464, 3.360 and 2.508; rich mothers 2.261, 1.995 and 2.452; having antenatal care 4 times and above 2.606, 2.570, 2.682; having transportation access 1.921, 1.956 and 2.404; having media access 1.979, 2.171 and 2.715 respectively. The odds of having attitude and practice respectively were as follows: married 1.762, and 2.208; having medium wealth index 1.933 and 2.424. The odds of having previous pregnancy complications was 2.147 which significantly affect the practice of seeking skilled maternal care assistance.

Conclusions

This study discovered that the study participants' knowledge, attitude, and practice of skilled maternal health care are low. Associated factors included age at first pregnancy, planned pregnancy, maternal education level, husband’s education level, maternal age, antenatal care service visits, transport access, and access to media were found to significantly affect the knowledge, attitude, and practice of the respondents in seeking skilled maternal care assistance in common. The household wealth index was also associated with attitude. Pregnancy complications, current marital status, and household wealth index also significantly affect the practice of seeking skilled maternal care assistance. As a result of the findings, initiatives to increase women's knowledge, attitudes, and use of expert maternal health services in the research area are needed for women residing in rural areas.

Effect of USAID-funded obstetric ultrasound service interventions on maternal and perinatal health outcomes at primary healthcare facilities in Ethiopia: a propensity score matching analysis

OBJECTIVE

A dimensional shift in the health service delivery in the primary healthcare setting is required to raise maternal and child well-being. This study aimed to evaluate the effect of US Agency for International Development-funded obstetric ultrasound service on maternal and perinatal health outcomes at Ethiopia's primary healthcare facilities.

DESIGN

We employed a quasi-experimental study design.

SETTING

The study was conducted in primary health centres located in four regions of Ethiopia.

PARTICIPANTS

We used 2 years' data of 1568 mothers from 13 intervention and 13 control primary health centres. Data were obtained from Vscan, antenatal care (ANC), delivery and postnatal care registers.

INTERVENTION

Use of portable obstetric ultrasound service during pregnancy.

OUTCOME MEASURES

The primary outcome variables include complete four ANC visits, referral during ANC, delivery in a health facility and having postnatal care and continuum of care. The secondary outcome variable was perinatal death.

RESULTS

With the kernel matching approach, we have found that having four or more ANC visits was decreased after the intervention (average treatment effect (ATE): -0.20; 95% CI: -0.23 to -0.09), and the rest of the indicators, including referral during ANC (ATE: 0.01; 95% CI: 0.15 to 0.34), institutional delivery (ATE: 0.24; 95% CI: 0.15 to 0.34) and postnatal care (ATE: 0.26; 95% CI: 0.10 to 0.37), were significantly raised because of the intervention. Similarly, we have found that perinatal death dropped considerably due to the intervention.

CONCLUSION

The findings show a consistent increase in maternal health service use because of the introduction of obstetric ultrasound services at the primary health centre level. Furthermore, early detection of complications and following referral for specialty care were found to be high. The consistent rise in maternal health service use indicators calls for additional trial to test the effect of obstetric ultrasound service in other locations of the country. Furthermore, evaluating the predictive values, sensitivity and specificity of the obstetric ultrasound service is important.

Maternal Service Coverage and Its Relationship To Health Information System Performance: A Linked Facility and Population-Based Survey in Ethiopia

Coverage for most maternal services showed promising performance. Improving the health information system performance can further improve maternal service uptake and quality.

Background:

Studies in Ethiopia show an increasing trend in maternal health service use, such as having at least 4 visits of antenatal care (ANC4+) and skilled birth attendance (SBA). Improving the health information system (HIS) is an intervention that can improve service uptake and quality. We conducted a baseline study to measure current maternal service coverage, HIS performance status, and their relationship.

Methods:

We conducted a linked health facility-level and population-based survey from September 2020 to October 2020. The study covers all regions of Ethiopia. For the population-based survey, 3,016 mothers were included. Overall, 81 health posts, 71 health centers, and 15 hospitals were selected for the facility survey. A two-stage sampling procedure was applied to select target households. The study used modified Performance of Routine Information System Management tools for the facility survey and a structured questionnaire for the household survey. Multilevel logistic regression was employed to account for clustering and control for likely confounders.

Results:

Maternal service indicators, ANC4+ visits (54.0%), SBA (75.8%), postnatal care (70.6%), and cesarean delivery (9%) showed good service uptake. All data quality and use indicators showed lower performance compared to the national target of 90%. Maternal education and higher levels of wealth index were significantly and positively associated with all selected maternal service indicators. Longer distance from health facilities was significantly and negatively associated with SBA and the maternal care composite indicator. Among HIS-related indicators, availability of electronic HIS tools was significantly associated with maternal care composite indicator and ANC4+.

Conclusions:

Maternal service indicators showed promising performance. However, current HIS performance is suboptimal. Both service user and HIS-related factors were associated with maternal service uptake. Conducting similar research outside of the project sites will be helpful to have a wider understanding and better coverage.

Individual and community-level factors associated with skilled birth attendants during delivery in Bangladesh: A multilevel analysis of demographic and health surveys

Background

Skilled birth attendants (SBAs) play a crucial role in reducing infant and maternal mortality. Although the ratio of skilled assistance at birth has increased in Bangladesh, factors associated with SBA use are unknown. The main goal of our study was to reveal the individual- and community-level factors associated with SBA use during childbirth in Bangladesh. We also showed the prevalence and trend of SBA use and related independent variables in Bangladesh over the past decade.

Methods

This study utilized the Bangladesh Health and Demographic Survey (BDHS) 2017–2018, a cross-sectional study. We used binary logistic regression to examine the extent of variation in SBA use attributable to the individual- and community-level variables.

Results

Overall, 53.35% of women received assistance from SBAs during childbirth. The average annual rate of increase (AARI) in the number of SBA-assisted births over the past 10 years was 8.88%. Respondents who gave birth at or above 19 years had 1.40 times (AOR = 1.40; 95% CI: 1.21–1.62) greater odds of having skilled delivery assistance than respondents aged 18 years old or less. Women and their husband’s education levels were significantly associated with using skilled assistance during delivery, with odds of 1.60 (AOR = 1.60; 95% CI: 1.45–2.01) and 1.41 (AOR = 1.41; 95% CI: 1.21–1.66), respectively compared to those with education up to primary level. Women from rich families and those receiving better antenatal care (ANC) visits were more likely to have professional delivery assistance. Community-level factors also showed significance towards having professional assistance while giving birth. Women from urban communities and those who utilized more than four ANC visits and had completed secondary or higher education showed a greater tendency to use an SBA during childbirth than their counterparts.

Conclusion

The use of SBAs during delivery was significantly associated with some individual- and community-level factors. To reduce maternal and child mortality, there is a need to focus on rural and uneducated people who are less likely to access these facilities. Special programs could increase awareness and help the poor community obtain the minimum facility in maternal care.

Decomposing maternal socioeconomic inequalities in Zimbabwe; leaving no woman behind

Background

Several studies in the literature have shown the existence of large disparities in the use of maternal health services by socioeconomic status (SES) in developing countries. The persistence of the socioeconomic disparities is problematic, as the global community is currently advocating for not leaving anyone behind in attaining Sustainable Development Goals (SDGs). However, health care facilities in developing countries continue to report high maternal deaths. Improved accessibility and strengthening of quality in the uptake of maternal health services (skilled birth attendance, antenatal care, and postnatal care) plays an important role in reducing maternal deaths which eventually leads to the attainment of SDG 3, Good Health, and Well-being.

Methods

This study used the Zimbabwe Demographic Health Survey (ZDHS) of 2015. The ZDHS survey used the principal components analysis in estimating the economic status of households. We computed binary logistic regressions on maternal health services attributes (skilled birth attendance, antenatal care, and postnatal care) against demographic characteristics. Furthermore, concentration indices were then used to measure of socio-economic inequalities in the use of maternal health services, and the Erreygers decomposable concentration index was then used to identify the factors that contributed to the socio-economic inequalities in maternal health utilization in Zimbabwe.

Results

Overall maternal health utilization was skilled birth attendance (SBA), 93.63%; antenatal-care (ANC) 76.33% and postnatal-care (PNC) 84.27%. SBA and PNC utilization rates were significantly higher than the rates reported in the 2015 Zimbabwe Demographic Health Survey. Residence status was a significant determinant for antenatal care with rural women 2.25 times (CI: 1.55–3.27) more likely to utilize ANC. Richer women were less likely to utilize skilled birth attendance services [OR: 0.20 (CI: 0.08–0.50)] compared to women from the poorest households. While women from middle-income households [OR: 1.40 (CI: 1.03–1.90)] and richest households [OR: 2.36 (CI: 1.39–3.99)] were more likely to utilize antenatal care services compared to women from the poorest households. Maternal service utilization among women in Zimbabwe was pro-rich, meaning that maternal health utilization favoured women from wealthy households [SBA (0.05), ANC (0.09), PNC (0.08)]. Wealthy women were more likely to be assisted by a doctor, while midwives were more likely to assist women from poor households [Doctor (0.22), Midwife (− 0.10)].

Conclusion

Decomposition analysis showed household wealth, husband’s education, women’s education, and residence status as important positive contributors of the three maternal health service (skilled birth attendance, antenatal care, and postnatal care) utilization outcomes. Educating women and their spouses on the importance of maternal health services usage is significant to increase maternal health service utilization and consequently reduce maternal mortality.

Individual and contextual factors affect the implementation fidelity of youth-friendly services, northwest Ethiopia: A multilevel analysis

BACKGROUND

The evaluation of all potential determinants of implementation fidelity of Youth-Friendly Services (YFS) is crucial for Ethiopia. Previous studies overlooked investigating the determinants at different levels. Therefore, this study aimed to assess the determinants of implementation fidelity of YFS considering individual and contextual levels.

METHODS

This study was conducted among 1,029 youths, from 11 health centers that are implementing the YFS in Central Gondar Zone. Data were collected by face to face interview and facility observation using a semi-structured questionnaire. A Bivariable multi-level mixed effect modelling was employed to assess the main determinants. Four separate models were fitted to reach the full model. The fitness of the model was assessed using Akaike Information Criterion (AIC) and level of significance was declared at p-values < 0.05. The results of fixed effects were presented as adjusted odds ratio (AOR) at their 95% CI.

RESULTS

Four hundred one (39.0%) of the respondents got the YFS with high level of fidelity. Had high level of involvement in the YFS provision (AOR = 1.35, 95% CI: 1.15, 1.57), knew any peer educator trained in YFS (AOR = 1.60, 95% CI: 1.36, 1.86), and involved as a peer educator (AOR = 1.46, 95% CI: 1.24, 1.71), were the individual level determinants. Whereas, got capacity building training; (AOR = 1.93, 95% CI (1.12, 3.48), got supportive supervision, (AOR 2.85, 95% CI (1.99, 6.37), had a separate waiting room (AOR = 9.84, 95%CI: 2.14, 17.79), and system in place to provide continuous support to staff (AOR = 2.81, 95%CI: 1.25, 6.34) were the contextual level determinants.

CONCLUSIONS

The level of implementation fidelity remains low. Both individual and contextual level determinants affect the implementation fidelity of YFS. Therefore, policy makers, planners, managers and YFS providers could consider both individual and contextual factors to improve the implementation fidelity.

Fetal Malnutrition and Associated Factors among Term Newborn Babies at Birth in South Gondar Zone Hospitals, Northwest Ethiopia

Background

Undernutrition contributes to almost half of all under-five deaths. Fetal malnutrition (FM) has been implicated in both short- and long-term consequences among fetal, neonatal, and adult life. Currently, Ethiopia lacks information on the prevalence of fetal malnutrition and its associated factors. This study, therefore, is aimed at assessing the prevalence of FM at birth and its associated factors in South Gondar zone hospitals, northwest Ethiopia.

Methods

A cross-sectional study was carried out from November 1, 2019, to April 30, 2020, among four hospitals of South Gondar zone. All women with their live newborns who met the eligibility criteria were included. Clinical assessment of nutritional status including other anthropometric measurements was done immediately after delivery. The newborn was declared as fetal malnourished if the clinical assessment of nutritional status cut-off point is less than 25. Data were collected by trained clinical midwives. Besides bivariate regression analysis, a multivariable logistic regression analysis was done to identify associations.

Results

A total of 1592 mothers with their live newborns participated in this study. The prevalence of fetal malnutrition was 21.7% (95% CI: 19.7-23.9). Intimate partner violence (AOR: 1.97, 95% CI: 1.52-2.56), placental weight less than 512 grams (AOR: 2.76, 95% CI: 2.13-3.57), and small for gestational age (AOR: 1.96, 95% CI: 1.46-2.62) were significantly associated with fetal malnutrition.

Conclusions

The prevalence of fetal malnutrition was a public health problem in this study. Intimate partner violence, placental weight, and small for gestational age were found the most significant variables. To avert fetal malnutrition, positive family relation and additional or balanced nutritional supplementation during pregnancy are critical. We recommend researchers do clinical follow-up research which comprises a detailed investigation of placental, maternal, and fetal factors including genes.

Negative Incentives for Noninstitutional Births Are Associated With a Higher Rate of Facility-Based Births in the Eastern Visaya Region, Philippines

Penalties imposed for noninstitutional deliveries by local government policies could motivate pregnant women to deliver at birthing facilities; however, local governments should address barriers to accessing a birthing facility in underserved areas before prohibiting noninstitutional deliveries.

In the Philippines, the “no home-birthing policy” implemented in 2008 has encouraged local governments to endorse ordinances that prohibit noninstitutional deliveries (NIDs). The Philippines’ social insurance scheme has also enabled them to provide incentive payments to women who deliver at birthing facilities (BFs). This study evaluated whether these positive and/or negative incentives were associated with an increased facility-based delivery (FBD) rate and examined challenges in implementing those incentive measures in the Eastern Visaya Region of the Philippines. Cross-sectional data were collected regarding delivery locations during 2017, and barangay-level data were collected regarding positive and negative incentives and the characteristics of 4,371 barangays in the region. Multivariate logistic regression analysis, using “ordinance with nonmonetary sanction” as the reference category, indicated that no ordinance to prohibit NIDs was significantly associated with a lower FBD rate (odds ratio [OR]: 0.90, P=.013), and ordinance with low cash penalty (OR: 1.37, P<.001) and high cash penalty (OR: 2.52, P<.001) had higher FBD rates. Positive incentives were not associated with FBD rates (OR: 1.02, P=.563). The FBD rate was also significantly associated with urban barangay status (OR: 1.45, P<.001), availability of a vehicle (OR: 3.19, P<.001), availability of public transportation to a government BF (OR: 1.25, P<.001), and distance to the most accessible government BF (OR: 0.89, P<.001). Substantial proportions of barangays had no vehicles available for transportation (34.1%) or no available vehicles and no public transportation to a government BF (5.5%). Although negative incentives for NIDs could motivate pregnant women to seek FBD, local governments in the Philippines should be aware of barriers that limit access to government BFs in underserved barangays before introducing those negative incentives. Above all, barangay-level investments in making a vehicle for transporting pregnant women might help address these barriers and increase the FBD rate.

Magnitude, trends and determinants of skilled delivery from Kilite-Awlaelo Health Demographic Surveillance System, Northern Ethiopia, 2009- 2017

Background

The fundamental approach to improve maternal and neonatal health is increasing skilled delivery rate. Women giving birth at health institutions can prevent maternal and neonatal deaths by getting skilled birth attendance. In Ethiopia, despite a significant decrease in maternal mortality over the past decade, still a significant number of women give birth at home. Moreover, evidence from population-based longitudinal studies on skilled delivery is limited. Therefore, this study aims to investigate the magnitude, trend, and determinants of skilled delivery in Kilite-Awlaelo Health Demographic Surveillance System (KA-HDSS), Northern Ethiopia.

Method

Population-based longitudinal study design was conducted by extracting data for nine consecutive years (2009–2017) from KA-HDSS database. In order to measure the trends of skilled delivery, KA-HDSS data sets were analyzed (2009–2017). Bivariate and multivariate analyses were performed using STATA version 16. A multivariable binary logistic regression model was fitted to assess determinants of skilled delivery and odds ratio with 95% CI was used to assess presence of associations at a 0.05 level of significance.

Results

The skilled delivery rate have continuously increased among reproductive age women from 15.12% (95% CI: 13.30% - 17.09%) in 2010 to 95.85% (95% CI: 94.58% - 96.895%) in 2017. The skilled delivery rate becomes high (> = 82) in the period of 2014–2017. Education, residence, marital status, occupation and antenatal care (ANC) visits were the most important determinants for skilled delivery among reproductive age women during the period of high skilled delivery rate (2014–2017). Women urban dwellers had about 28 times (AOR = 27.66; 95% CI: 3.86–196.97) higher odds to deliver by skilled birth attendants than rural dwellers. Unmarried women who gave birth were 2.18 (AOR: 2.18; 95% CI: 1.30–3.64) times more likely to have skilled delivery service compared to those married. Likewise, women with four or more ANC visits were 3.2 times more likely to undergo skilled delivery service than those having no ANC visits (AOR: 3.16; 95% CI: 2.33–4.28). Moreover, women having at least a secondary education were 2 times more likely to have skilled delivery service compared to those women with no formal education (AOR = 2.10, 95% CI: 1.18–3.74).

Conclusion

Regardless of the importance of health facility delivery, a significant number of women still deliver at home attended by unskilled birth attendants. There has been a substantial increase in use of health facilities for delivery among women in the reproductive age. The factors affecting skilled delivery among reproductive age women were educational level, residence, marital status, occupation and use of ANC service. Maternal health related interventions are needed to change women’s attitudes towards skilled delivery. Moreover, ANC coverage should be increased to improve skilled delivery service.

Assessment of Knowledge, Attitude, and Practice of Skilled Assistance Seeking Maternal Healthcare Services and Associated Factors among Women in West Shoa Zone, Oromia Region, Ethiopia

Background

This study aimed to assess women's knowledge, attitude, and practice towards skilled assistance seeking maternal healthcare services in West Shoa Zone, Oromia Region, Ethiopia.

Methods

Cross-sectional survey design was conducted from 1 February to 23 March 2018 in West Shoa Zone, Oromia, Ethiopia. A simple random sampling technique was used to select the participants. The data were collected using a pretested and structured questionnaire. Data were entered using EpiData version 3.1, and descriptive analysis and bivariate and multivariate logistic regression analyses were carried out using SPSS version 20 statistical software package.

Results

The study revealed that the knowledge, attitude, and practice towards skilled maternal health services were found such that 473.3 (72.4%) of the study participants had good knowledge, 180.7 (27.6%) had poor knowledge, and 400 (61.3%) had positive attitude, 254 (38.84%) had negative attitude, 460.3 (70.4%) had good practice, and 193.7 (29.6%) had poor practice towards skilled maternal health services. Factors that had a significant association with antenatal care utilization were planned pregnancy (AOR = 8.2, 95% CI = 3.39-19.78-0.87) and access to transport (AOR = 3.1, 95% CI = 1.46–6.61). Attending ANC at least once (AOR = 3.1, 95% CI = 1.13–8.41), women's education (AOR = 3.0, 95% CI = 1.18–7.84), and unplanned pregnancy (AOR = 0.3, 95% CI = 0.21–0.75) were factors associated with skilled delivery service utilization. Attending ANC at least once (AOR = 2.1, 95% CI = 1.1–4.2), birth complications (AOR = 2.2, 95% CI = 1.35–3.66), unplanned pregnancies (AOR = 0.3, 95% CI = 0.22–0.68), and awareness about skilled obstetric care (AOR = 3.7, 95% CI = 1.68–12.79) were factors associated with postnatal care utilization.

Conclusions

This study found that the knowledge, attitude, and practice of skilled maternal health services among the study participants are low, showing less than three-quarters of the total sample size. Therefore, this study implied that interventions are required to improve women's knowledge, attitude, and practice of skilled maternal health services in the study area. Furthermore, women's education is significantly associated with skilled delivery service utilization. Accordingly, this study recommends that improving equity among the marginalized population is needed to increase maternal health service coverage.

Low and unequal use of outpatient health services in public primary health care facilities in southern Ethiopia: a facility-based cross-sectional study

BACKGROUND

Outpatient department visits per individual for each year are one of the core indicators of healthcare delivery to assess accessibility or quality of services. In addition, this study aimed to assess health service utilisation and disease patterns in southern Ethiopia, by including the health authorities' suggestions to improve the services. No study has assessed this in Ethiopia previously.

METHODS

An institution-based cross-sectional design study was done in 65 primary health care units in Dale and Wonsho districts, in Sidama region, for all patients visiting health facilities from 1 July 2017 to 30 June 2018. We estimated the utilisation rate as visits per person per year, the odds ratio for health use and proportions of diseases' diagnoses. The results of our study were presented to local health authorities, and their suggestions for improvements were incorporated into the analysis.

RESULT

A total of 81,129 patients visited the health facilities. The annual outpatient health service utilisation was 0.18 (95% CI: 0.18-0.19) new visits per person per year. The health service utilisation rate per year for the rural population was lower than the urban utilisation by 91% (OR = 0.09; 95% CI: 0.08-0.09). Children in the age group of 5-14 years had lower odds of health service utilisation by 78% (OR = 0.22; 95% CI: 0.21-0.23), compared to children under 5 years of age. Females were four times (OR = 4.17; 95% CI: 4.09-4.25) more likely to utilise health services than males. Febrile illness constituted 17.9% (14,847 of 83,148) of the diagnoses in all age groups. Almost half of the febrile cases, 46.5% (3827 of 8233), were among children under 5 years of age. There were very few cases of non-communicable diseases diagnosed in the health facilities. The health authorities suggested improving diagnostic capacities at health centres, enhancing health professionals' skill and attitudes, and improving affordability and physical accessibility of the services.

CONCLUSION

The health service utilisation rate was low in Sidama. The use of health services was lower among rural residents, men, children and elderly, and health post users. Improving the quality, affordability and accessibility of the health services, by involving responsible stakeholders could increase service usage.

Maternal healthcare coverage for first pregnancies in adolescent girls: a systematic comparison with adult mothers in household surveys across 105 countries, 2000-2019

Background

Effective maternal service delivery for adolescent mothers is essential in achieving the targets for maternal mortality under the Sustainable Development Goals. Yet little is known about levels of maternal service coverage in adolescents compared with adult mothers.

Method

We used data from 283 Demographic and Health Surveys or Multiple Cluster Indicator Surveys for 105 countries between 2000 and 2019 to estimate the levels and trends of inequality in coverage of five maternal health services between adolescent girls (aged 15–19) and adult mothers (aged 20–34), including receiving four or more antenatal care visits, delivering with skilled birth attendants and receiving a postnatal check-up within 24 hours of delivery.

Results

We analysed data from 0.9 million adolescent girls and 2.4 million adult mothers. Using the most recent data, we found adolescent girls had poorer coverage across all indicators, with receipt of four or more antenatal care visits 6.5 (95% CI 6.3 to 6.7) percentage points lower than adult mothers, delivery with skilled birth attendants 3.6 (95% CI 3.4 to 3.8) lower and having a postnatal check-up within 24 hours of delivery 3.2 (95% CI 2.8 to 3.6) lower. The coverage was 54.2% (95% CI 53.9 to 54.5) among adolescents for four or more antenatal care visits, 69.7% (95% CI 69.4 to 70.0) for delivery with skilled birth attendants and only 30.0% (95% CI 29.3 to 30.7) for receiving a postnatal check-up within 24 hours of delivery. Country-specific coverage of the maternal services increased over time in most countries, but age-related differences persisted and even worsened in some, particularly in the Western Pacific (eg, Vietnam, Lao, Cambodia and Philippines).

Conclusion

Even though their pregnancies are of higher risk, adolescent girls continue to lag behind adult mothers in maternal service coverage, suggesting a need for age-appropriate strategies to engage adolescents in maternal care.

Spatial variability in factors influencing maternal health service use in Jimma Zone, Ethiopia: a geographically-weighted regression analysis

BACKGROUND

Persisting within-country disparities in maternal health service access are significant barriers to attaining the Sustainable Development Goals aimed at reducing inequalities and ensuring good health for all. Sub-national decision-makers mandated to deliver health services play a central role in advancing equity but require appropriate evidence to craft effective responses. We use spatial analyses to identify locally-relevant barriers to access using sub-national data from rural areas in Jimma Zone, Ethiopia.

METHODS

Cross-sectional data from 3727 households, in three districts, collected at baseline in a cluster randomized controlled trial were analysed using geographically-weighted regressions. These models help to quantify associations within women's proximal contexts by generating local parameter estimates. Data subsets, representing an empirically-identified scale for neighbourhood, were used. Local associations between outcomes (antenatal, delivery, and postnatal care use) and potential explanatory factors at individual-level (ex: health information source), interpersonal-level (ex: companion support availability) and health service-levels (ex: nearby health facility type) were modelled. Statistically significant local odds ratios were mapped to demonstrate how relevance and magnitude of associations between various explanatory factors and service outcomes change depending on locality.

RESULTS

Significant spatial variability in relationships between all services and their explanatory factors (p < 0.001) was detected, apart from the association between delivery care and women's decision-making involvement (p = 0.124). Local models helped to pinpoint factors, such as danger sign awareness, that were relevant for some localities but not others. Among factors with more widespread influence, such as that of prior service use, variation in estimate magnitudes between localities was uncovered. Prominence of factors also differed between services; companion support, for example, had wider influence for delivery than postnatal care. No significant local associations with postnatal care use were detected for some factors, including wealth and decision involvement, at the selected neighbourhood scale.

CONCLUSIONS

Spatial variability in service use associations means that the relative importance of explanatory factors changes with locality. These differences have important implications for the design of equity-oriented and responsive health systems. Reductions in within-country disparities are also unlikely if uniform solutions are applied to heterogeneous contexts. Multi-scale models, accommodating factor-specific neighbourhood scaling, may help to improve estimated local associations.

Delay in health-seeking behaviour: Implication to yellow fever outcome in the 2019 outbreak in Nigeria

Yellow fever is a vaccine-preventable acute viral disease that can rapidly spread and cause serious public health impact. Delay in seeking health care from health facilities is a potential risk of prolonged disease spread. Therefore, this study assessed the delay in health-seeking behaviour and implications for yellow fever outcomes in the 2019 outbreak in Nigeria. Furthermore, the study examined the factors associated with delayed yellow fever vaccine uptake. A retrospective study was conducted from January to December 2019 using 137 cases recorded in the WHO database. The data were analysed using descriptive (frequency and percentages) and the Chi-square test. The results were significant at p < 0.05. Results showed a low uptake of yellow fever vaccine (24.1%) among patients and a median total health-seeking delay of 7 [IQR 7, 9] days. The delay was more among the older age ≥40 years (12 [IQR 12, 29]), females (8 [IQR 8, 11], and rural inhabitants 7 [IQR7, 9], particularly in Izzi LGA (9 [IQR 9, 16] than the other subgroups. Patients' location or place of residence was significantly associated with the yellow fever vaccine uptake (p < 0.000*), and delay (p = 0.003*). Conclusively, the low vaccine uptake was due to the delay in health-seeking behaviour. Thus, the healthcare system in Nigeria needs to intensify mass participation in immunisation programmes. Interventions that promote behavioural change towards immunisation are required. Also, health promotion campaigns to educate rural people on desirable health-seeking behaviour are needed.

Childbirth at home and associated factors in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Maternal mortality remains a major challenge to health systems worldwide. Although most pregnancies and births are uneventful, approximately 15% of all pregnant women develop potentially life-threatening complications. Childbirth at home in this context can be acutely threatening, particularly in developing countries where emergency care and transportation are less available. Therefore, this systematic review and meta-analysis aimed to assess the prevalence of home childbirth and its associated factors among women in Ethiopia at their last childbirth.

METHOD

For this review, we used the standard PRISMA checklist guideline. This search included all published and unpublished observational studies written only in English language and conducted in Ethiopia. PubMed/Medline, Hinari, EMBASE, Google Scholar, Science Direct, Scopus, Web of Science (WoS), ProQuest, Cochrane Library, African Journals Online, Ethiopian's university research repository online library were used. Based on the adapted PICO principles, different search terms were applied to achieve and access the essential articles from February 1-30, 2020. The overall selected search results were 40 studies. Microsoft Excel was used for data extraction and Stata version 11.0 (Stata Corporation, College Station, Texas, USA) for data analysis. The quality of individual studies was appraised by using the Joanna Briggs Institute (JBI) quality appraisal checklist. The heterogeneity of the studies was assessed by the Cochrane Q and I2 test. With the evidence of heterogeneity, subgroup analysis and sensitivity analysis were computed. The pooled prevalence of childbirth at home and the odds ratio (OR) with a 95% confidence interval was presented using forest plots.

RESULT

Seventy-one thousand seven hundred twenty-four (71, 724) mothers who gave at least one birth were recruited in this study. The estimated prevalence of childbirth at home in Ethiopia was 66.7% (95%CI: 61.56-71.92, I2 = 98.8%, p-value < 0.001). Being from a rural area (adjusted odds ratio (AOR) 6.48, 95% confidence interval (CI): 3.48-12.07), being uneducated (AOR = 5.90, 95% CI: 4.42-7.88), not pursuing antenatal (ANC) visits at all (AOR = 4.57(95% CI: 2.42-8.64), having 1-3 ANC visits only (AOR = 4.28, 95% CI: 3.8-8.26), no birth preparedness and complication readiness plan (AOR = 5.60, 95% CI: 6.68-8.25), no media access (AOR = 3.46, 95% CI: 2.27-5.27), having poor knowledge of obstetric complications (AOR = 4.16: 95% CI: 2.84-6.09), and walking distance more than 2 hours to reach the nearest health facility (AOR = 5.12, 95% CI: 2.94-8.93) were the factors associated with giving childbirth at home.

CONCLUSION

The pooled prevalence of childbirth at home was high in Ethiopia. Being from a rural area, being uneducated, not pursuing ANC visits at all, having 1-3 ANC visits only, no media access, having poor knowledge of obstetric complications, not having a birth preparedness and complication readiness plan, and walking time greater than 2 hours to reach the nearest health facility increased the probability of childbirth at home in Ethiopia.

Assessing the contextual effect of community in the utilization of postnatal care services in Ghana

BACKGROUND

Inequalities in the use of postnatal care services (PNC) in Ghana have been linked to poor maternal and neonatal health outcomes. This has ignited a genuine concern that PNC interventions with a focus on influencing solely individual-level risk factors do not achieve the desired results. This study aimed to examine the community-level effect on the utilization of postnatal care services. Specifically, the research explored clusters of non-utilization of PNC services as well as the effect of community-level factors on the utilization of PNC services, with the aim of informing equity-oriented policies and initiatives.

METHODS

The 2014 Ghana Demographic and Health Survey GDHS dataset was used in this study. Two statistical methods were used to analyze the data; spatial scan statistics were used to identify hotspots of non-use of PNC services and second two-level mixed logistic regression modeling was used to determine community-level factors associated with PNC services usage.

RESULTS

This study found non-use of PNC services to be especially concentrated among communities in the Northern region of Ghana. Also, the analyses revealed that community poverty level, as well as community secondary or higher education level, were significantly associated with the utilization of PNC services, independent of individual-level factors. In fact, this study identified that a woman dwelling in a community with a higher concentration of poor women is less likely to utilize of PNC services than those living in communities with a lower concentration of poor women (Adjusted odds ratio (AOR) = 0.60, 95%CI: 0.44-0.81). Finally, 24.0% of the heterogeneity in PNC services utilization was attributable to unobserved community variability.

CONCLUSION

The findings of this study indicate that community-level factors have an influence on women's health-seeking behavior. Community-level factors should be taken into consideration for planning and resource allocation purposes to reduce maternal health inequities. Also, high-risk communities of non-use of obstetric services were identified in this study which highlights the need to formulate community-specific strategies that can substantially shift post-natal use in a direction leading to universal coverage.

Disparities in antenatal care service utilization among food secure and food insecure women in Gombora District, Hadiya zone, south Ethiopia

Introduction

little is known about antenatal care (ANC) utilization difference among food secure and food insecure household pregnant women and factors contributing to inequities in antenatal care use in developing country including Ethiopia. To determine the disparities in the utilization of antenatal care that exists between pregnant women in food secure and food insecure household women.

Methods

a community based comparative cross-sectional study was conducted in Gombora District, Hadiya zone, southern Ethiopia. Data were collected from February 25^th to March 25^th, 2015, using a pre-tested structured questionnaire. Pregnant women were selected by a simple random sampling method. The data were entered using EpiData 3.1 and exported to SPSS version 21 for analysis. Multivariate logistic regression analysis was done to compare antenatal care utilization among food secure and insecure household women at 95% confidence interval (CI). Statistical tests were done at a level of significance of p<0.05.

Results

two hundred sixty-seven (34.5%) of the respondents received at least one antenatal care visit on current pregnancy. Forty-nine-point one percent of food secure and 23.3% of food insecure household women utilized ANC from health professionals. Factors associated with antenatal care utilization included being from a food secure household (adjusted odds ratio [aOR]= 2.54; 95%CI: 1.79-3.59), having attained secondary or higher education (aOR=3.76; 95%CI: 2.32-6.1), good level of knowledge of antenatal care (aOR= 2.42; 95%CI 1.34-4.33) and being from a wealthy household (aOR=2.10; 95% CI: 1.34-3.28). Conclusion: this study showed a significant variation in the use of ANC in food secure and food insecure household pregnant women. Interventions to improve ANC utilization should prioritize women from poor socio-economic and low educational background.

Individual and community socioeconomic factors related to the quality of antenatal care: a multilevel analysis of West and Central Africa

Antenatal care (ANC) can improve maternal health. We examined associations of individual and community socioeconomic status (SES) with the quality of ANC in West and Central Africa. Data were from the 2009-2011 UNICEF Multiple Indicator Cluster Surveys for women in seven countries (n = 24,718). Individual SES variables included women's education and wealth; community SES was defined as low or high poverty index. ANC quality was defined as receiving six services: blood pressure monitoring, blood tests, urine tests, malaria prophylaxis, tetanus vaccine, and HIV screening, and coded low or high. We used multilevel logistic regression to estimate fixed and random effects of individual and community SES on ANC quality. Less than one-fourth of women received high-quality ANC. Only small percentages of women had malaria prophylaxis and were counseled and tested for HIV. In adjusted country-stratified results, living in a poor community was associated with reduced odds of receiving high-quality ANC in six countries (Central African Republic: odds ratio, OR = 0.76; 95% confidence interval, CI:0.58-0.98; Chad: OR = 0.48; CI:0.32-0.74; Ghana: OR = 0.86; CI:0.61-0.97; Nigeria: OR = 0.74; CI:0.61-0.92; Sierra Leone: OR = 0.71; CI:0.57-0.91; and Togo: OR = 0.80; CI:0.47-0.91). The health system may be missing important opportunities to provide high-quality ANC and, thereby, improve pregnancy outcomes in these settings.

Level of Happiness and Its Associated Factors Among Pregnant Women in South Gondar Zone Hospitals, North Central Ethiopia

Background

Happiness is the most indicator of good quality of life particularly for pregnant women. Reduced happiness of pregnant women can result in reduced maternal health services utilization and can result in adverse newborn and maternal outcomes. Assessing the level of happiness and its factors are important for pregnant women and the next generation. Hence, the current research paper aimed to assess the level of happiness and its associated factors among pregnant women who attended antenatal care follow-up in South Gondar Zone Hospitals.

Methods

Institution-based cross-sectional study was carried out from September 2018 to February 2019 among 1606 expectant pregnant women in the last 6 months. The Oxford Happiness Questionnaire (OHQ) was used as a measure of the degree of happiness and used four as average person score. Besides, bivariate, multivariable logistic analyses were deployed to identify associations.

Results

A total of 1606 pregnant women were participating in this study. The prevalence of low level of pregnancy happiness in this study was 24% (95% CI: 20.7 −26.6). Mothers who exposed to unintended pregnancy (AOR; 1.94, CI 95% 1.86–4.52), reported intimate partner violence (AOR; 2.42, 95% CI 1.67–3.54) and being in the third trimester (AOR; 1.89 95% CI 1.19–3.01) were the most predictor variables with the low level of happiness.

Conclusion

Approximately one-fourth of the pregnant women had a low level of pregnancy happiness. Mothers who were exposed to unintended pregnancy encountered intimate partner violence, who were in the third trimester were the most significant variables associated with a low level of happiness. Governmental and non-governmental organizations work on women’s reproduction rights and the zonal health department with local health offices should educate on the prevention of intimate partner violence and unintended pregnancy and its consequences and also empower women to cope with changes and challenges of pregnancy and childbirth.

Why do women not use skilled birth attendance service? An explorative qualitative study in north West Ethiopia

BACKGROUND

Having a birth attendant with midwifery skills during childbirth is an effective intervention to reduce maternal and early neonatal morbidity and mortality. Nevertheless, many women in Ethiopia still deliver a baby at home. The current study aimed at exploring and describing reasons why women do not use skilled delivery care in North West Ethiopia.

METHODS

This descriptive explorative qualitative research was done in two districts of West Gojjam Zone in North West Ethiopia. Fourteen focus group discussions (FGDs) were conducted with pregnant women and mothers who delivered within one year. An inductive thematic analysis approach was employed to analyse the qualitative data. The data analysis adhered to reading, coding, displaying, reducing, and interpreting data analysis steps.

RESULTS

Two major themes client-related factors and health system-related factors emerged. Factors that emerged within the major theme of client-related were socio-cultural factors, fear of health facility childbirth, the nature of labour, lack of antenatal care (ANC) during pregnancy, lack of health facility childbirth experience, low knowledge and poor early care-seeking behaviour. Under the major theme of health system-related factors, the sub-themes that emerged were low quality of service, lack of respectful care, and inaccessibility of health facility.

CONCLUSIONS

This study identified a myriad of supply-side and client-related factors as reasons given by pregnant women, for not giving birth in health institution. These factors should be redressed by considering the specific supply-side and community perspectives. The results of this study provide evidence that could help policymakers to develop strategies to address barriers identified, and improve utilisation of skilled delivery service.

Intrauterine growth restriction and its associated factors in South Gondar zone hospitals, Northwest Ethiopia, 2019

BACKGROUND

After prematurity, intrauterine growth restriction (IUGR) is the second leading cause of perinatal mortality. IUGR has significant consequences in fetal, neonatal, and adult life. Currently, Ethiopia lacks information on IUGR's prevalence and its determinants. This study aimed to assess the proportion of IUGR at birth and its associated factors.

METHODS

A cross-sectional study was carried out among women who give birth in four hospitals of south Gonder zone from November 2018 to February 2019. Multi-stage sampling was applied to select the required samples. IUGR was assessed using a standardized cutoff percentile/mean for each measurement. Data were collected by trained MSc clinical midwives. Bi-variable and multivariable logistic analyses were deployed to identify the association.

RESULTS

A total of 803 maternity women were participating in this study with a response rate of 95%. The proportion of IUGR 23.5% (95% CI: 20.7-26.6), low birth weight 13.3%, small-for- gestational-age 19.7%,and preterm birth 23.16%. Women who was unable to read and write, (AOR; 2.46, 95% CI: 1.02-5.92), total family size ≥7 (AOR; 1.67, 95% CI: 1.04-2.66), maternal mid-upper arm circumference (MUAC) < 23 cm (AOR; 2.10, 95% CI: 1.39-3.01), body mass index (BMI) < 18.5 kg/m2 (AOR; 2.57, 95% CI: 1.72-3.83), altitude > 3000 m (AOR; 1.89 95% CI: 1.19-3.01), small placental size (< 350 g) (AOR; 2.42, 95% CI: 1.67-3.54) and small-for-gestational-age (AOR; 1.94, 95% CI:1.86-4.52) were the most predictors of IUGR.

CONCLUSIONS

IUGR was a major public health concern in this study. Women who were unable to read and write, small-for-gestational-age, maternal BMI < 18.5 kg/m2, family size ≥7, maternal MUAC < 23 cm, small placental size, and altitude > 3000 m were found the most predictor variables. Strengthen female education, nutritional intervention before and during pregnancy, and routine maternity care is critical. Further clinical follow-up research is essential which includes maternal, fetal, and placental gens.

Determinants of postnatal care utilization in Ethiopia: a multilevel analysis

BACKGROUND

The expansion of primary health care services in Ethiopia made basic health services available and accessible. The Last Ten Kilometers (L10K) project has strengthened the primary health care system through implementing innovative strategies to engage local communities to improve maternal and newborn health care behavior and practices in Amhara, Oromia, Southern Nations, Nationalities and Peoples [SNNP], and Tigray regions over a decade. Despite the efforts of the government and its partners to improve the use of maternal health services, the coverage of postnatal care is persistently low in the country. This study examined the individual and community level determinants for the persistently low uptake of postnatal care in the project areas.

METHODS

The study used a cross-sectional population-based survey that measured maternal and newborn health care practices among women who had live births in the last 12 months preceding the survey in Amhara, Oromia, SNNP, and Tigray regions. Multilevel random effects binary logistic regression analysis was used to assess the independent effects of community-and individual-level factors and moderating effects on the uptake of postnatal care.

RESULTS

This study identified region of residence, obstetric factors, and health service-related factors to be significant determinants for use of postnatal care. Obstetric factors include knowledge of obstetric danger signs (AOR: 1.30; 95% CI: 1.05-1.60), cesarean section mode of delivery (AOR: 1.96; 95% CI: 1.28-3.00), and institutional delivery (AOR: 10.29; 95% CI: 7.57-13.98). While the health service-related factors include attended family conversation during pregnancy (AOR: 1.48; 95% CI: 1.04-2.12), birth notification (AOR: 2.66; 95% CI: 2.15-3.29), home visits by community health workers (AOR: 1.98; 95% CI: 1.58-2.50), and being recognized as a model family (AOR: 1.27; 95% CI: 1.03-1.57).

CONCLUSION

This study demonstrated that community-level interactions and promotive health services including antepartum home visits by community health workers, family conversation, birth notification, and model family, are important determinants to seek postnatal care. The findings also highlight the need for expansion of health facilities or design appropriate strategies to reach the disadvantaged communities. Program managers are recommended to strengthen community-based interventions to improve postnatal care utilization.

Trends and determinants of home delivery in Ethiopia: further multivariate decomposition analysis of 2005-2016 Ethiopian Demographic Health Surveys

OBJECTIVE

This study aimed to assess the trends and factors that had contributed to the change in home delivery in Ethiopia over the last decade.

DESIGN, SETTING AND ANALYSIS

A nationally representative repeated cross-sectional survey was conducted using 2005, 2011 and 2016 Ethiopian Demographic and Health Surveys. Multivariate decomposition logistic regression analysis was employed to identify significant factors that have been contributed to the change in home delivery. Level of statistical significance was declared at a two-sided p value <0.05.

OUTCOME MEASURE

Trends of home delivery.

PARTICIPANTS

A total of 33 482 women were included.

RESULTS

Home delivery has been decreased by 21% over the last decade in Ethiopia. In the last decade, 39% of the decrements in home delivery attributed to change in women's compositional characteristics. Antenatal care visits, educational status of the women and husband, birth order, religion, wealth index and distance from a health facility were the main sources of compositional change factors for the change of home delivery. Behavioural changes towards health facility delivery contributed approximately two-thirds of the decline of home delivery in Ethiopia. Antenatal care visits, birth order and religion have significantly contributed to the change of home delivery resulted from behavioural changes towards healthcare facility utilisation over the last decade.

CONCLUSION

Despite the importance of health facility delivery, a significant number of women still deliver at home in Ethiopia. Women's compositional characteristics and behaviour changes were significantly associated with the change in home delivery. Multisectoral educational intervention is needed to change women's attitudes towards home delivery. Antenatal care coverage and healthcare facility coverage should increase thereby to improve healthcare facility based-delivery practice. Further research needs to be done to explore the potential barriers of health facility delivery from a religious perspective.

Determinants of the Continuum of Maternal Healthcare Services in Northwest Ethiopia: Findings from the Primary Health Care Project

Background

The maternity continuum of care is the continuity of maternal healthcare services that a woman uses, which includes antenatal care (ANC 4+), skill birth attendant (SBA), and postnatal care (PNC) within 48 hours of delivery. It is one of the essential strategies for reducing maternal and newborn mortality. This study aimed to assess the factors associated with the completion of a continuum of maternal healthcare services among mothers who gave birth in the past five years.

Methods

A community-based cross-sectional study was conducted from May 01 to June 29, 2019, among 565 randomly selected mothers who gave birth in five years before the study in primary healthcare project implementation districts of north Gondar zone, Amhara National Regional State, Ethiopia. Bivariable and multivariable logistic regression analysis were computed, and in the multivariable logistic regression analysis, adjusted odds ratio (AOR) with 95% confidence interval (CI) and a p value of less than 0.05 were used to identify the associated factors with completion of the continuum of maternal healthcare services.

Results

The study revealed that the overall completion of the continuum of maternal healthcare services was 21.60% (95% CI: 18.20, 24.90). Women who were able to read and write (AOR: 2.70, 95% CI: 1.22, 6.04), using car/motorcycle as a means of transportation to get the health facility (AOR: 5.59, 95% CI: 2.29, 9.50), travel time less than an hour to get the health facility (AOR: 4.98, 95% CI: 2.97, 8.38), being satisfied with the service delivery (AOR: 1.89, 95% CI: 1.15, 3.11), and getting health education on maternal healthcare services in the last 6 months (AOR: 2.77, 95% CI: 1.52, 5.05) were factors associated with the completion of the continuum of maternal healthcare services.

Conclusions

The completion of the continuum of maternal healthcare services was relatively low, indicating that women were not getting the likely health benefit from the present health services. Therefore, interventions should focus on increasing women's awareness, improving the availability of services at nearby health facilities, and improving service delivery by considering women's preferences and needs to increase their satisfaction are essential to increase the completion of maternal healthcare services.

Determinants of institutional delivery service utilization in Ethiopia: a population based cross sectional study

Background

The incidence of maternal mortality remains unacceptably high in developing countries. Ethiopia has developed many strategies to reduce maternal and child mortality by encouraging institutional delivery services. However, only one-fourth of women gave birth at health facility, in the country. This, this study aimed to identify individual level factors and to assess the regional variation of institutional delivery utilization in Ethiopia.

Methods

Data were obtained from the 2016 Ethiopian demographic and health survey. In this study, a total of 7174 reproductive age women who had birth within five years were included. We fitted multilevel logistic regression model to identify significantly associated factors associated with institutional delivery. A mixture chi-square test was used to test random effects. Statistical significance was declared at p < 0.05, and we assessed the strength of association using odds ratios with 95% confidence intervals.

Result

The level of institutional delivery was 38.9%. Women’s who had focused antenatal care (FANC) visit (AOR = 3.12, 95% CI: 2.73–3.56), multiple gestations (AOR = 2.06, 95% CI: 1.32–3.21, and being urban residence (AOR = 7.18, 95% CI: 5.10–10.12) were more likely to give birth at health facility compared to its counterpart. Compared to women’s without formal education, giving birth at health facility was more likely for women’s who had primary education level (AOR = 1.77, 95% CI: 1.49–2.10), secondary education level (AOR = 3.79, 95% CI: 2.72–5.30), and higher education level (AOR = 5.86, 95% CI: 3.25–10.58). Furthermore, women who reside in rich (AOR = 2.39, 95% CI: 1.86–3.06) and middle (AOR = 1.66, 95% CI: 1.36–2.03) household wealth index were more likely to deliver at health facility compared to women’s who reside poor household wealth index. Moreover, this study revealed that 34% of the total variation in the odds of women delivered at health institution accounted by regional level.

Conclusion

The level of institutional delivery in Ethiopia remains low. Context specific and tailored programs that includes educating women and improving access to ANC services has a potential to improve institutional delivery in Ethiopia.

Factors affecting the utilization of antenatal care among married women of reproductive age in the rural Thatta, Pakistan: findings from a community-based case-control study

Background

There are differences in antenatal care (ANC) utilization between urban and rural areas of Pakistan. Although multiple factors have been studied affecting the utilization of general health care services, the effect of road network distance particularly on the utilization of ANC has not been assessed. Therefore, this study aimed to determine the association between road network distance from a health care facility and utilization of the ANC among women of reproductive age in Thatta Pakistan.

Methods

A community-based case-control study was conducted in district Thatta, Pakistan. Women who did not utilize ANC services during their last pregnancy were considered as cases, while controls were the women who utilized ANC services during their last pregnancy. Questions related to socio-demographic, access-related factors and utilization of ANC were asked from women. Road network distance was calculated from the women’s home to the health care facility providing ANC services. Logistic regression analysis was performed.

Results

A total of 380 participants were interviewed in this study. Participants’ mean age and parity were 28 years (SD 5.65), and 3.5 (SD 2.6) respectively. The multivariate analysis showed that women living at a shorter distance of less than 5 km were 1.21 times likely to utilize ANC services [Adjusted OR. 1.21; 95% CI (0.49–2.99)]. Moreover, nulliparous women were 4.10 times likely to utilize antenatal care [Adjusted OR. 4.10; 95% CI (1.10–15.26)]. Similarly, women who had knowledge of antennal care were 6.60 times likely to utilize ANC services [Adjusted OR. 6.60; 95% CI (3.33–13.05)]. Women having electricity in their households were 3.15 times likely to utilize the ANC services [Adjusted OR. 3.11 95% CI (1.51–6.41)]. Women, living in well-constructed (Pakka) houses were 2.58 times likely to utilize the ANC services [Adjusted O.R: 2.58; 95% CI (1.15–5.82)].

Conclusion

Road network distance has no measurable impact on ANC utilization among married women in Thatta district, Pakistan. Nulliparous women having knowledge of ANC living in well-constructed houses equipped with electricity were found to be utilizers of ANC services. It is recommended that awareness and health education sessions should be arranged for pregnant women in rural Pakistan.

Spatio-temporal distribution and associated factors of home delivery in Ethiopia. Further multilevel and spatial analysis of Ethiopian demographic and health surveys 2005-2016

Background

Globally, between 2012 and 2017, 80% of live births occurred at health facilities assisted by skilled health personnel. In Ethiopia, in 2016 only 26% of live births attended by skilled health personal. This study aimed to assess the spatial patterns and associated factors of home delivery in Ethiopia using 2005, 2011, and 2016 Ethiopian Demographic and Health Surveys.

Methods

A total of 33,482 women who gave live birth in the 5 years preceding each survey were included for this study. ArcGIS version 10.7 software was used to visualize the spatial distribution of home delivery. The Bernoulli model was applied using Kilduff SaTScan version 9.6 software to identify significant purely spatial clusters for home delivery in Ethiopia. A multilevel logistic regression model was fitted to identify factors associated with home delivery. A p-value < 0.05 was taken to declare statistically significant predictors.

Results

Home delivery was declined from 94.78% in 2005, 90.05% in 2011, and 73.44% in 2016 in Ethiopia. Among the three surveys, consistently high clustering of home delivery was observed in Amhara and Southern Nations Nationalities and People’s Regions (SNNPR) of Ethiopia. In spatial scan statistics analysis, a total of 128 clusters (RR = 1.04, P-value < 0.001) in 2005, and 90 clusters (RR = 1.11, P-value < 0.001) in 2011, and 55 clusters (RR = 1.29, P-value < 0.001) in 2016 significant primary clusters were identified. Educational status of women and husband, religion, distance to the health facility, mobile access, antenatal care visit, birth order, parity, wealth index, residence, and Region were statistically significant predictors of home delivery.

Conclusion

The spatial distribution of home delivery among the three consecutive surveys were non-random in Ethiopia. Educational status of women and husband, religion, distance to the health facility, wealth index, residence, parity, mobile access, Region, and antenatal care visit were statistically significant predictors of home delivery in Ethiopia. Therefore, an intervention needs to improve the coverage of antenatal care visit, and health care facilities. Ministry of health and other stakeholders should give special attention to women living in Amhara and SNNPR states of Ethiopia.

Giving birth in Ethiopia: a spatial and multilevel analysis to determine availability and factors associated with healthcare facility births

OBJECTIVE

To assess spatial variations in the use of healthcare facilities for birth and to identify associated factors.

DESIGN

Cross-sectional analysis of population- and healthcare facility-based data.

SETTING

Ethiopia Demographic and Health Survey (EDHS 2016) linked to Service Provision Assessment data (SPA 2014).

POPULATION

A sample of 6954 women who gave birth in the 5 years preceding EDHS 2016 and 717 healthcare facilities providing delivery care.

METHODS

Secondary data analysis of linked population and health facility data was conducted. Multilevel and spatial analyses were conducted to identify key determinants of women's use of health facilities for birth and to assess spatial clustering of facility births.

MAIN OUTCOME MEASURE

Health facility birth.

RESULTS

A one-unit increase in the mean score of the readiness of health facilities to provide basic emergency obstetric care (EmOC) was associated with a two-fold increase in the odds of facility birthing (adjusted odds ratio, aOR, 2.094, 95% CI 1.187-3.694). A woman's attendance for at least four antenatal care visits was significantly associated with facility birth (aOR 8.863, 95% CI 6.748-11.640). Distance to a healthcare facility was inversely related to a woman's use of facility birthing (aOR 0.967, 95% CI 0.944-0.991). Women in the richest wealth quintile were also more likely to have facility births (aOR 2.892, 95% CI 2.199-3.803).

CONCLUSIONS

There were geographic variations in facility births in Ethiopia, revealing critical gaps in service availability and readiness. It is important to ensure that health facilities are in a state of readiness to provide EmOC.

TWEETABLE ABSTRACT

Failure to ensure health facility readiness is associated with failure to give birth at a healthcare facility.

Postnatal Care within One Week and Associated Factors among Women Who Gave Birth in Ameya District, Oromia Regional State, Ethiopia, 2018: Cross Sectional Study

BACKGROUND

Globally recorded large number of maternal and neonatal deaths are related to complications during pregnancy, childbirth and post-partum. Most neonatal deaths occur during the first week of life. It is also evidenced that the level of postnatal care utilization in Ethiopia is very low. This study aimed to assess postnatal care utilization within one week and associated factors among women who had given birth in the last six weeks in Ameya district, Oromia, Ethiopia.

METHODS

Cross sectional study design was employed on 332 study participants who were selected by systemic sampling method and interviewed using structured questionnaires. The data were analyzed using SPSS version 23.0. Bivariate and multivariate logistic regression analysis was used to identify the associated factors with the outcome variable. Figures, tables and sentences were used for the presentation of descriptive statistics.

RESULT

The finding revealed that the proportion of postnatal care utilization within one-week in the study area is 25.3%. Partner occupation [AOR=5.575, 95% CI= (1.071, 29.023)], mothers who had complication during labor and delivery[AOR=7.841, 95% CI= (2.287, 26.879)], distance from mothers to health facilities[AOR= 5.127, 95% CI= (1.149, 22.878)] and awareness on postnatal care within one week services[AOR=4.161, 95% CI= (1.300, 13.314)] were the main contributing factors of postnatal care utilization within one-week.

CONCLUSION

Postnatal care utilization within one-week is very low (25.3%). Partner occupation, complication during labor and delivery, distance from health facilities and awareness on postnatal care within one week service were the associated factors.

Women's retention on the continuum of maternal care pathway in west Gojjam zone, Ethiopia: multilevel analysis

Background

The continuum of maternal care has been one of the effective approaches for improving the health of mothers and newborns. Although large numbers of Ethiopian women do not use maternal health services, points of drop out along the continuum are not understood well. Understanding of a particular point of maternal care dropout on the continuum, however, helps governments make effective interventions. This study aimed to assess the extent of women’s service utilization and the factors affecting retention on the continuum of care in West Gojjam Zone, Ethiopia.

Methods

A community-based study linked to health facility data was conducted in June 2018. Data were obtained from 1281 mothers who gave birth to their last baby within the preceding 12 months from a two-stage cluster sampling. Data were collected via face-to-face interviews using a pretested questionnaire. Multilevel logistic regression models were used to examine the effects of individual and cluster-level factors on key elements of the continuum of care. The measure of fixed effects was expressed as Odds Ratio with 95% confidence interval.

Results

The study revealed that only 12.1% of women completed the continuum of maternal care services (ANC4+, SBA, and PNC within 2 days after birth); while 25.1% of them did not receive any care during their recent births. There were commonalities and differences in the predictors of the three indicators of maternal health service utilization. Variables related to services received during antenatal care such as early initiation of ANC (AOR = 7.53, 95%CI, 2.94, 19.29) and receiving proper contents (AOR = 3.31, 95%CI, 1.08, 10.16) were among the predictors significantly associated with the completion of the continuum of care.

Conclusions

The continuum of maternal care completion rate was extremely low, indicating that women were not getting the maximum possible health benefit from existing health services. The results also revealed that maternal health service utilization was influenced by factors operating at various levels-individual, household, community, and health facility. Since antenatal care is considered an entry point for the subsequent use of maternal services, strategies that aimed to improve maternal health service utilization should target early initiation and antenatal care quality.

Factors associated with postnatal care utilization among postpartum women in Ethiopia: a multi-level analysis of the 2016 Ethiopia demographic and health survey

BACKGROUND

Most postpartum women and newborns do not utilize postnatal care due to less emphasis given especially in developing countries. Understanding individual and community-level factors associated with postnatal care will help to design appropriate strategies and policies for improving service utilization. Therefore, this study aimed to assess individual and community-level factors associated with postnatal care utilization in Ethiopia.

METHOD

This study used the Ethiopian Demographic and Health Survey (EDHS) data of 2016. A total of 4489 women who gave birth 2 years before the survey were included. Two-stage stratified cluster sampling technique was used. The analysis was done using Stata version 14.0 after checking for basic assumptions of multilevel logistic regression. Multilevel mixed-effects logistic regression was used to identify determinants of postnatal care utilization. An adjusted odds ratio with a 95% confidence interval was used to show the strength and direction of the association.

RESULTS

Husband with secondary education [AOR = 0.17, 95% CI = (0.04, 0.68)], four or more antenatal care visit [AOR = 10.77, 95% CI = (2.65, 43.70)], middle wealth quintile [AOR = 3.10, 95% CI = (1.12, 8.58)] were individual level factors. Community level education [AOR = 2.53, 95% CI = (1.06, 6.06)] and community level of health service utilization [AOR = 2.32, 95% CI = (1.14, 4.73)] were the predictors at community level.

CONCLUSION

Wealth index, number of antenatal care visits, husband education, community level of education and health service utilization were significantly associated with PNC service utilization. Provision of quality antenatal care, improvement of the educational status of women and husband involvement in PNC are important strategies to increase PNC service utilization.

An evidence-based policy brief: improving the quality of postnatal care in mothers 48 hours after childbirth

Introduction

Malawi is experiencing slow progress in postnatal care of mothers within the first 48 hours after childbirth. Malawi Demographic and Health Survey (MDHS) 2015–16 reported a slow progress in postnatal care of mothers in the first 48 hours at 42% from 41% in 2010 despite a high number of institutional births. This is a critical period as a large proportion of maternal deaths occur during this period, currently at 439 per 100,000 live births. During postnatal care the mother is given important information to assist in caring for herself and her baby. The lack of well documented guidelines and funding to employ more midwives to manage mothers in postnatal ward contributes to poor quality of postnatal care.

Methods

This is an evidence-based policy brief that was prepared to inform policy makers, health workers, clients, community and other stakeholders to consider the available evidence about the impact of the suggested options in order to improve postnatal care.

Results

Several factors that contribute to low utilization of postnatal care among mothers after childbirth were identified. Factors included lack of clear guidelines on postnatal care, shortage of skilled health workers and inadequate resources.

Conclusion

Implementation of the identified policy options may improve postnatal care.

Influences of health facility type for delivery and experience of cesarean section on maternal and newborn postnatal care between birth and facility discharge in Malawi

Background

A number of studies in the past have looked at determinants of postnatal care. However, many of them do not distinguish between postnatal care (PNC) before discharge and after discharge for women delivering at health facilities. Conceptually and practically, factors associated with PNC before discharge and after discharge should be different. This study examines key factors for maternal and newborn PNC before discharge.

Methods

Data from the 2015–16 Malawi Demographic and Health Survey were used for the study. Three categorical endogenous variables examined in the study were whether or not mothers received a postnatal check between birth and facility discharge, whether or not newborns received a postnatal check between birth and facility discharge and whether or not women delivered by cesarean section. Delivery by cesarean section was considered as a mediator in the model. The main predictor of interest was type of health facility where women delivered. Other exogenous variables included were women’s age at most recent birth, number of antenatal visits, women’s education, household wealth, parity, newborn size, region of the country and residence. Simultaneous equation modeling was used to examine the associations of interest.

Results

47% of the mothers and 68% of the newborns had PNC before facility discharge. The total and direct effects of delivering in private hospitals on maternal and newborn PNC before facility discharge were significantly higher than the effects of delivering in government hospitals. The total effects of delivering in government health centers or health posts on maternal and newborn PNC before facility discharge were significantly lower than the effects of delivering in government hospitals. Delivering by cesarean section compared to delivering vaginally was positively associated with maternal and newborn PNC before facility discharge.

Conclusion

It is important that all women and newborns receive PNC before they are discharged from the facility regardless of whether or not they had a complication. The same standard of quality PNC should be provided equitably across all types and affiliations of health facilities.

Women's Perspectives on Influencers to the Utilisation of Skilled Delivery Care: An Explorative Qualitative Study in North West Ethiopia

Skilled attendance at birth is widely regarded as an effective intervention to reduce maternal and early neonatal morbidity and mortality. However, many women in Ethiopia still deliver without skilled assistance. This study was carried out to identify factors that influenced or motivated women to give birth in a health facility in their previous, current, and future pregnancies. This descriptive explorative qualitative study was conducted in two districts of West Gojjam zone in North West Ethiopia. Fourteen focus group discussions were conducted with pregnant women and women who gave birth within one year. An inductive thematic analysis approach was employed to analyze the qualitative data. In this study, two major themes and a number of subthemes emerged from the focus group discussions with the study participants. The factors that influenced or motivated women to give birth in health facility in their previous, current, and future pregnancies include access to ambulance transport service, prevention of mother to child HIV transmission service, referral service, women friendly service, and emergency obstetric services, good interpersonal care from health workers, and fear and experience of obstetric danger signs and complications. In addition, reception of information and advice on importance of skilled delivery care and obstetric danger signs and complications from health workers, use of antenatal care, previous use of skilled delivery care, ensuring wellbeing of parturient women and newborns, and use of emergency obstetric care were also identified as influencers and motivators for health facility childbirth in previous, current, and future deliveries. Increased understanding of the factors that influenced or motivated women to deliver in facilities could contribute to developing strategies to improve the uptake of facility-based maternity services and corresponding declines in maternal morbidity and mortality.

Effectiveness of participatory community solutions strategy on improving household and provider health care behaviors and practices: A mixed-method evaluation

Introduction

We implemented a participatory quality improvement strategy in eight primary health care units of Ethiopia to improve use and quality of maternal and newborn health services.

Methods

We evaluated the effects of this strategy using mixed-methods research. We used before-and-after (March 2016 and November 2017) cross-sectional surveys of women who had children 0–11 months to compare changes in maternal and newborn health care indicators in the 39 communities that received the intervention and the 148 communities that did not. We used propensity scores to match the intervention with the comparison communities at baseline and difference-in-difference analyses to estimate intervention effects. The qualitative method included 51 in-depth interviews of community volunteers, health extension workers, health center directors and staff, and project specialists.

Results

The difference-in-difference analyses indicated that 7.9 percentage points (95% confidence interval [CI]: 1.8–13.9%) increase in receiving skilled delivery care between baseline and follow-up surveys in the intervention area that is attributable to the strategy. The intervention effect on postnatal care in 48 hours of the mother was 15.3% (95% CI: 7.4–23.2). However, there was no evidence that the strategy affected the seven other maternal and newborn health care indicators considered. Interview participants said that the participatory design and implementation strategy helped them to realize gaps, identify real problems, and design appropriate solutions, and created a sense of ownership and shared responsibility for implementing interventions.

Conclusions

Community participation in planning and monitoring maternal and newborn health service delivery improves use of some high-impact maternal and newborn health services. The study supports the notion that participatory community strategies should be considered to foster community-responsive health systems.