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Dessalegn M, Negesse A, Deresse T, Yigzaw Birhanu M, Agedew E, Dires G. Perioperative mortality rate and its predictors after emergency laparatomy at Debre Markos comprehensive specialized hospital, Northwest Ethiopia: 2023: retrospective follow-up study. BMC Surg 2024; 24:114. [PMID: 38627671 PMCID: PMC11020798 DOI: 10.1186/s12893-024-02401-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Emergency laparatomy is abdominal surgery associated with a high rate of mortality. There are few reports on rates and predictors of postoperative mortality, whereas disease related or time specific studies are limited. Understanding the rate and predictors of mortality in the first 30 days (perioperative period) is important for evidence based decision and counseling of patients. This study aimed to estimate the perioperative mortality rate and its predictors after emergency laparatomy at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia, 2023. METHODS This was a Hospital-based retrospective follow-up study conducted at Debre Markos Comprehensive Specialized Hospital in Ethiopia among patients who had undergone emergency laparatomy between January 1, 2019 and December 31, 2022. Sample of 418 emergency laparatomy patients selected with simple random sampling technique were studied. The data were extracted from March 15, 2023 to April 1, 2023 using a data extraction tool, cleaned, and entered into Epi-Data software version 3.1 before being exported to STATA software version 14.1 for analysis. Predictor variables with P value < 0.05 in multivariable Cox regression were reported. RESULTS Data of 386 study participants (92.3% complete charts) were analyzed. The median survival time was 18 days [IQR: (14, 29)]. The overall perioperative mortality rate in the cohort during the 2978 person-days of observations was 25.5 per 1000 person-days of follow-up [95% CI: (20.4, 30.9))]. Preoperative need for vasopressor [AHR: 1.8 (95% CI: (1.11, 2.98))], admission to intensive care unit [AHR: 2.0 (95% CI: (1.23, 3.49))], longer than three days of symptoms [AHR: 2.2 (95% CI: (1.15, 4.02))] and preoperative sepsis [AHR: 1.8 (95% CI: (1.05, 3.17))] were identified statistically significant predictors of perioperative mortality after emergency laparatomy. CONCLUSIONS The perioperative mortality rate is high. Preoperative need for vasopressors, admission to intensive care unit, longer than three days of symptoms and preoperative sepsis were predictors of increased perioperative mortality rate.
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Affiliation(s)
- Megbar Dessalegn
- Department of Surgery, School of Medicine, Debre Markos University, Debre Markos, Ethiopia.
| | - Ayenew Negesse
- Department of Human Nutrition, Health Science College, Debre Markos University, Debre markos, Ethiopia
| | - Tilahun Deresse
- Department of Surgery, School of Medicine, Debre Birhan University, Debre Markos, Ethiopia
| | - Molla Yigzaw Birhanu
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Eskeziyaw Agedew
- College of Health Sciences, Debre Markos University, Debre markos, Ethiopia
| | - Gedefaw Dires
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Abredu J, Dwumfour CK, Alipitio B, Alordey M, Dzomeku VM, Witter S. A scoping review of the residual barriers to skilled birth attendance in Ghana: A conceptual framework and a fish bone analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002902. [PMID: 38346065 PMCID: PMC10861047 DOI: 10.1371/journal.pgph.0002902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/18/2024] [Indexed: 02/15/2024]
Abstract
The achievement of the Sustainable Development Goals (SDGs) targets 3.1, 3.2 and 3.3.1 is strongly dependent on the effective utilization of skilled birth services. Despite advancements made in Skilled Birth Attendance (SBA) in Ghana, there are still instances of unassisted childbirths taking place. The aim of this study was to explore the residual barriers of SBA such as community- and health system-related factors affecting SBA in Ghana and to identify strategies for addressing them. An electronic search was done using PubMed, Popline, Science direct, BioMed Central, Scopus and Google scholar for peer reviewed articles as well as grey articles from other relevant sources, published between 200 and 2022 on community- and health system related factors influencing SBA in Ghana. Out of the 89 articles retrieved for full screening, a total of 52 peer-reviewed articles and 1 grey article were selected for the final review. The study revealed that cultural practices (community factors), low quality of service delivery due to the inappropriate behaviors, lack of competency of skilled birth attendants (SBAs) as well as the inefficient distribution of SBAs contribute to ineffective uptake of SBA (health system factors). Also, indirect costs are associated with the utilization of skilled delivery care even with the existence of 'free' delivery care policy under the national health insurance (policy factor). For Ghana to achieve the SDGs above and improve SBA, it is essential to enhance the quality of skilled delivery care by addressing the attitude and competencies of skilled birth professionals, while plans are put in place to expand and develop the Community-based Health Planning and Services (CHPS) strategy to help address the access barriers to SBA. More so, the 'free' delivery care policy should absorb all the costs associated with skilled delivery for pregnant women as it is intended for.
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Affiliation(s)
- Juliet Abredu
- Ho Nurses’ Training College, Ho, Ghana
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, United Kingdom
| | - Catherine K. Dwumfour
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Boo Alipitio
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Veronica Millicent Dzomeku
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sophie Witter
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, United Kingdom
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Idris IB, Hamis AA, Bukhori ABM, Hoong DCC, Yusop H, Shaharuddin MAA, Fauzi NAFA, Kandayah T. Women's autonomy in healthcare decision making: a systematic review. BMC Womens Health 2023; 23:643. [PMID: 38042837 PMCID: PMC10693143 DOI: 10.1186/s12905-023-02792-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/19/2023] [Indexed: 12/04/2023] Open
Abstract
OBJECTIVES Although there are calls for women's empowerment and gender equity globally, there are still large disparities regarding women's autonomy in healthcare decision making. The autonomy of women is believed to be crucial in improving their health-related outcomes. This review discusses factors that influence autonomy among women in healthcare decision making. DESIGN Systematic review. DATA SOURCES PubMed, Web of Science and Scopus were searched from 2017-2022. ELIGIBILITY CRITERIA The inclusion criteria include original articles, case studies and reports that has been written in the English Language, while manuscripts with no full article, reviews, newspaper reports, grey literatures, and articles that did not answer the review objectives were excluded. DATA EXTRACTION AND SYNTHESIS We carried out data extraction using a standardized data extraction form, that has been organized using Microsoft Excel. A narrative synthesis was carried out to combine the findings of all included articles. RESULTS A total of 70 records were identified and 18 were reviewed, yielding eight articles to be included in the accepted list of studies. All studies were conducted in developing countries and most of the studies were cross sectional. Factors that were associated with women's autonomy in healthcare decision making were age, women's education and occupation, husbands'/partners' education and occupation, residential location or region of residence, household wealth index as well as culture and religion. CONCLUSIONS Identification of these factors may help stakeholders in improving women's autonomy in healthcare decision making. Policymakers play a crucial role in healthcare decision making by enacting laws and policies that protect women's rights, promoting gender-sensitive healthcare services, ensuring access to comprehensive information, promoting health education, and supporting vulnerable populations. These efforts ensure women's autonomy including able to access to unbiased and effective healthcare services.
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Affiliation(s)
- Idayu Badilla Idris
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, 56000, Malaysia.
| | - Amy Azira Hamis
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, 56000, Malaysia
| | - Ayuzeity Bistari Md Bukhori
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, 56000, Malaysia
| | - David Chan Chee Hoong
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, 56000, Malaysia
| | - Hakimah Yusop
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, 56000, Malaysia
| | - Muhammad Al-Amin Shaharuddin
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, 56000, Malaysia
| | - Nazmeen Adline Fawwazah A Fauzi
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, 56000, Malaysia
| | - Thinakaran Kandayah
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, 56000, Malaysia
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Deresse T, Tesfahun E, Gebreegziabher ZA, Bogale M, Alemayehu D, Dessalegn M, Kifleyohans T, Eskandar G. Perioperative Adverse Outcome and Its Predictors After Emergency Laparotomy Among Sigmoid Volvulus Patients: Retrospective Follow-Up Study. Open Access Emerg Med 2023; 15:383-392. [PMID: 37876607 PMCID: PMC10591608 DOI: 10.2147/oaem.s430193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023] Open
Abstract
Background Acute sigmoid volvulus is a surgical emergency with closed-loop obstruction of the colon that often requires emergency laparotomy, which is associated with a multitude of post-operative complications. Although sigmoid volvulus is the main cause of intestinal obstruction in Ethiopia, local studies of its management outcomes are limited. Objective To assess the magnitude and predictors of adverse perioperative outcomes of emergency laparotomy for acute sigmoid volvulus in the Debre Markos Comprehensive Specialized Hospital (DMCSH), Amhara region, Ethiopia in 2023. Methods This was a retrospective follow-up study. Descriptive statistics were used to measure perioperative outcomes and other study variables. Bivariable and multivariable logistic regression models were used to identify the predictors of adverse surgical outcomes. Associations were considered significant at p < 0.05 (95% confidence interval). Results In total, 170 study participants were enrolled, with a response rate of 91.4%. Forty-nine patients (28.8%) developed perioperative adverse outcomes. Pneumonia (29 patients, 28.1%), surgical site infection (19 patients, 18.4%), and wound dehiscence (10 patients, 9.7%) were the most common complications. Pre-operative shock [AOR: 3.87 (95% CI: (1.22, 12.28))], pus or fecal matter contamination of the peritoneum [AOR: 4.43 (95% CI: (1.35, 14.47)], and a higher American Society of Anesthesiologists (ASA) score [AOR: 2.37 (95% CI: (1.05, 5.34))] were identified as predictors of perioperative adverse events. Conclusion The perioperative adverse outcomes in this study were higher than those reported in Ethiopian national and global reports following emergency laparotomies. Hypotension at presentation, pus and/or fecal matter contamination of the peritoneum, and higher ASA scores are strong predictors of increased perioperative adverse outcomes. Therefore, healthcare providers and institutions involved in the delivery of emergency surgical care should emphasize the importance of early surgical intervention, adequate resuscitation, and patient monitoring to improve perioperative outcomes.
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Affiliation(s)
- Tilahun Deresse
- Department of Surgery, Debre Berhan University, Debre Berhan, Ethiopia
| | - Esubalew Tesfahun
- Department of Public Health, Debre Berhan University, Debre Berhan, Ethiopia
| | | | - Mandante Bogale
- Department of Surgery, Debre Markos University, Debre Markos, Ethiopia
| | - Dawit Alemayehu
- Department of Surgery, Debre Markos University, Debre Markos, Ethiopia
| | - Megbar Dessalegn
- Department of Surgery, Debre Markos University, Debre Markos, Ethiopia
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Cofie LE, Barrington C, Cope K, LePrevost CE, Singh K. Increasing health facility childbirth in Ghana: the role of network and community norms. BMC Pregnancy Childbirth 2023; 23:265. [PMID: 37076794 PMCID: PMC10114363 DOI: 10.1186/s12884-023-05513-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 03/13/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Reducing pregnancy-related deaths in Sub-Saharan Africa through increases in health facility births may be achieved by promoting community norms and network norms favoring health facility births. However, the process of how both norms shift attitudes and actions towards facility delivery is little studied. We examined the association of network and community norms with facility birth, following a quality improvement intervention to improve facility births in Ghana. METHODS A 2015 mixed methods evaluation of a Maternal and Newborn Health Referral (MNHR) project in Ghana included a cross-sectional survey of women (N = 508), aged 15-49 years; in-depth interviews (IDIs) with mothers (n = 40), husbands (n = 20) and healthcare improvement collaborative leaders (n = 8); and focus group discussions (FGDs) with mothers-in-law (n = 4) and collaborative members (n = 7). Multivariable logistic regression was used to examine the association of network and community norms with facility birth. Thematic analysis of the qualitative data was conducted to explain this relationship. RESULTS The network norm of perceived family approval of facility delivery (AOR: 5.54, CI: 1.65-18.57) and the community norm of perceived number of women in the community that deliver in a facility (AOR: 3.00, CI: 1.66-5.43) were independently associated with facility delivery. In qualitative IDIs and FGDs both norms were also collectively perceived as influencing facility delivery. However, network norms were more influential in women's utilization of facility-based pregnancy-related care. Healthcare improvement collaboratives were important in swaying both network and community norms toward facility-based delivery by offering pregnancy-related health information, antenatal care, and support for facility delivery. CONCLUSION Quality improvement initiatives impact both community and network norms. To be most impactful in advancing facility-based pregnancy-related care, these initiatives should focus on highlighting the shifting trend toward facility delivery in rural communicates and promoting support for facility delivery among women's personal networks.
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Affiliation(s)
- Leslie E Cofie
- Department of Health Education and Promotion, East Carolina University, 3104 Belk Building, Greenville, NC, 27858, USA.
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 302 Rosenau Hall, Chapel Hill, NC, CB #744027599-7440, USA
- Carolina Population Center, University of North Carolina, CB#81200, Chapel Hill, NC, 27599-7440, USA
| | - Kersten Cope
- University of South Carolina, Health Promotion, Education, and Behavior, 915 Greene Street, Columbia, SC, 29208, USA
| | - Catherine E LePrevost
- Department of Applied Ecology, North Carolina State University, 237 David Clark Labs, Raleigh, NC, 27695, USA
| | - Kavita Singh
- Carolina Population Center, University of North Carolina, CB#81200, Chapel Hill, NC, 27599-7440, USA
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Rosenau HallChapel Hill, NC, CB #744527599-7445, USA
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Chung EO, Hagaman A, Bibi A, Frost A, Haight SC, Sikander S, Maselko J. Mother-in-law childcare and perinatal depression in rural Pakistan. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221141288. [PMID: 36468464 PMCID: PMC9726850 DOI: 10.1177/17455057221141288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Mothers-in-law often provide key childcare support to daughters-in-law during the perinatal period that may enhance maternal mental health. Yet, poor mother-in-law/daughter-in-law relationships may be associated with maternal depression. The extent to which mother-in-law childcare involvement affects perinatal depression may differ across contexts of family conflict. OBJECTIVE We explored the relationship between mother-in-law childcare and daughter-in-law perinatal depression in rural Pakistan across contexts of family conflict. METHODS Data on 783 women came from the Bachpan Cohort, a birth cohort in Pakistan. Maternally-reported mother-in-law childcare was assessed at 3 and 12 months postpartum using a 24-h recall and categorized into no, low, and high involvement. Major depression was captured at 3 and 12 months using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV. Family conflict was captured using three items from the Life Events Checklist. Log-Poisson models were used to estimate cross-sectional associations between mother-in-law childcare and perinatal depression, stratified by family conflict. RESULTS Mother-in-law childcare was common in the first year postpartum. The association between mother-in-law childcare and perinatal depression differed by the presence of family conflict and postpartum timing. At 3 months postpartum, low and high mother-in-law childcare (vs no involvement) were associated with a lower prevalence of depression regardless of family conflict. At 12 months postpartum, among families with no conflict, low mother-in-law childcare (vs no involvement) was associated with lower perinatal depression; however, among families with conflict, high mother-in-law childcare was associated with increased perinatal depression. CONCLUSION Our findings highlight the complexities of associations between mother-in-law childcare support and perinatal depression in the first year after birth. Mother-in-law childcare in the immediate postpartum period was beneficial for mothers. Understanding the source, amount, timing, and context of social support is necessary to inform research and interventions that aim to improve maternal mental health.
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Affiliation(s)
- Esther O Chung
- Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Esther O Chung, Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA.
| | - Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA,Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA
| | - Amina Bibi
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan,Human Development Research Foundation, Islamabad, Pakistan
| | - Allison Frost
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sarah C Haight
- Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Siham Sikander
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan,Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Joanna Maselko
- Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Litorp H, Kågesten A, Båge K, Uthman O, Nordenstedt H, Fagbemi M, Puranen B, Ekström AM. Gender norms and women’s empowerment as barriers to facility birth: A population-based cross-sectional study in 26 Nigerian states using the World Values Survey. PLoS One 2022; 17:e0272708. [PMID: 35980968 PMCID: PMC9387800 DOI: 10.1371/journal.pone.0272708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background Central and western Africa struggle with the world’s lowest regional proportion of facility birth at 57%. The aim of the current study was to compare beliefs related to maternal health care services, science/technology, gender norms, and empowerment in states with high vs. low proportions of facility birth in Nigeria. Methods Face-to-face interviews were performed as part of a nationally representative survey in Nigeria using a new module to measure values and beliefs related to gender and sexual and reproductive health and rights collected as part the 2018 World Values Survey. We compared beliefs related to maternal health care services, science/technology, gender norms, and empowerment between Nigerian states with facility birth proportions > 50% vs. < 25% as presented in the 2018 Nigerian Demographic Health Survey report. Pearson’s chi-squared test, the independent t-test, and univariable and multivariable logistic and linear regression were used for analyses. Results were also stratified by gender. Results Among the 1,273 participants interviewed, 653 resided in states with high and 360 resided in states with low proportions of facility birth. There were no significant differences between the groups in perceived safety of facility birth (96% vs. 94%) and confidence in antenatal care (91% vs 94%). However, in states with low proportions of facility birth, participants had higher confidence in traditional birth attendants (61% vs. 39%, adjusted odds ratio [aOR] 2.1, [1.5–2.8]), men were more often perceived as the ones deciding whether a woman should give birth at a clinic (56% vs. 29%, aOR 2.4 [1.8–3.3]), and participants experienced less freedom over their own lives (56% vs. 72%, aOR 0.56 [0.41–0.76]). Most differences in responses between men and women were not statistically significant. Conclusions In order to increase facility births in Nigeria and other similar contexts, transforming gender norms and increasing women’s empowerment is key.
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Affiliation(s)
- Helena Litorp
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Anna Kågesten
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Båge
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Olalekan Uthman
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Helena Nordenstedt
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Bi Puranen
- World Values Survey, Stockholm, Sweden
- Institute for Future Studies, Stockholm, Sweden
| | - Anna-Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Mamo A, Abera M, Abebe L, Bergen N, Asfaw S, Bulcha G, Asefa Y, Erko E, Bedru KH, Lakew M, Kurji J, Kulkarni MA, Labonté R, Birhanu Z, Morankar S. Maternal social support and health facility delivery in Southwest Ethiopia. Arch Public Health 2022; 80:135. [PMID: 35546410 PMCID: PMC9092803 DOI: 10.1186/s13690-022-00890-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 05/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal mortality continues to decrease in the world but remain the most important health problems in low-income countries. Although evidence indicates that social support is an important factor influencing health facility delivery, it has not been extensively studied in Ethiopia. Therefore, this study aimed to assess the effect of maternal social support and related factors on health facility delivery in southwest Ethiopia. METHODS A cross-sectional survey data on 3304 women aged 15-47 years in three districts of Ethiopia, were analyzed. Using multivariable logistic regression, we assessed the association between health facility birth, social support, and socio-demography variables. Adjusted odds ratios with 95% confidence intervals were used to identify statistically significant associations at 5% alpha level. RESULT Overall, 46.9% of women delivered at health facility in their last pregnancy. Average travel time from closest health facility (AOR: 1.51, 95% CI 1.21 to 2.90), mean perception score of health facility use (AOR: 1.83, 95% CI 1.44 to 2.33), involvement in final decision to identify their place of childbirth (AOR: 2.12, 95% CI 1.73 to 2.58) had significantly higher odds of health facility childbirth. From social support variables, women who perceived there were family members and husband to help them during childbirth (AOR: 3.62, 95% CI 2.74 to 4.79), women who received continuous support (AOR: 1.97, 95% CI 1.20 to 3.23), women with companions for facility visits (AOR: 1.63, 95% CI 1.34 to 2.00) and women who received support from friends (AOR: 1.62, 95% CI 1.16 to 3.23) had significantly higher odds of health facility childbirth. CONCLUSIONS Social support was critical to enhance health facility delivery, especially if women's close ties help facility delivery. An intervention to increase facility delivery uptake should target not only the women's general social supports, but also continuous support during childbirth from close ties including family members and close friends as these are influential in place of childbirth. Also actions that increase women's healthcare decision could be effective in improving health facility delivery.
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Affiliation(s)
- Abebe Mamo
- Department of Health, Behavior and Society, Faculty of Public Health, Institute of Health, Jimma University, PO Box 378, Jimma, Ethiopia.
| | - Muluemebet Abera
- Department of population and family health, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Lakew Abebe
- Department of Health, Behavior and Society, Faculty of Public Health, Institute of Health, Jimma University, PO Box 378, Jimma, Ethiopia
| | - Nicole Bergen
- School of Epidemiology and Public Health, University of Ottawa, Ontario, K1G 5Z3, Canada
| | - Shifera Asfaw
- Department of Health, Behavior and Society, Faculty of Public Health, Institute of Health, Jimma University, PO Box 378, Jimma, Ethiopia
| | | | - Yisalemush Asefa
- Department of Health Policy & Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Endale Erko
- Maternal and Child Health Directorate, Addis Ababa City Administration Health Bureau, Maternal Health, Family Planning and AYH Advisor, Addis Ababa, Ethiopia
| | | | | | - Jaameeta Kurji
- School of Epidemiology and Public Health, University of Ottawa, Ontario, K1G 5Z3, Canada
| | - Manisha A Kulkarni
- School of Epidemiology and Public Health, University of Ottawa, Ontario, K1G 5Z3, Canada
| | - Ronald Labonté
- School of Epidemiology and Public Health, University of Ottawa, Ontario, K1G 5Z3, Canada
| | - Zewdie Birhanu
- Department of Health, Behavior and Society, Faculty of Public Health, Institute of Health, Jimma University, PO Box 378, Jimma, Ethiopia
| | - Sudhakar Morankar
- Department of Health, Behavior and Society, Faculty of Public Health, Institute of Health, Jimma University, PO Box 378, Jimma, Ethiopia
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Budu E, Chattu VK, Ahinkorah BO, Seidu AA, Mohammed A, Tetteh JK, Arthur-Holmes F, Adu C, Yaya S. Early age at first childbirth and skilled birth attendance during delivery among young women in sub-Saharan Africa. BMC Pregnancy Childbirth 2021; 21:834. [PMID: 34906105 PMCID: PMC8670119 DOI: 10.1186/s12884-021-04280-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 11/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background Despite the numerous policy interventions targeted at preventing early age at first childbirth globally, the prevalence of adolescent childbirth remains high. Meanwhile, skilled birth attendance is considered essential in preventing childbirth-related complications and deaths among adolescent mothers. Therefore, we estimated the prevalence of early age at first childbirth and skilled birth attendance among young women in sub-Saharan Africa and investigated the association between them. Methods Demographic and Health Survey data of 29 sub-Saharan African countries was utilized. Skilled birth attendance and age at first birth were the outcome and the key explanatory variables in this study respectively. Overall, a total of 52,875 young women aged 20-24 years were included in our study. A multilevel binary logistic regression analysis was performed and the results presented as crude and adjusted odds ratios at 95% confidence interval. Results Approximately 73% of young women had their first birth when they were less than 20 years with Chad having the highest proportion (85.7%) and Rwanda recording the lowest (43.3%). The average proportion of those who had skilled assistance during delivery in the 29 sub-Saharan African countries was 75.3% and this ranged from 38.4% in Chad to 93.7% in Rwanda. Young women who had their first birth at the age of 20-24 were more likely to have skilled birth attendance during delivery (aOR = 2.4, CI = 2.24-2.53) than those who had their first birth before 20 years. Conclusion Early age at first childbirth has been found to be associated with low skilled assistance during delivery. These findings re-emphasize the need for sub-Saharan African countries to implement programs that will sensitize and encourage the patronage of skilled birth attendance among young women in order to reduce complications and maternal mortalities. The lower likelihood of skilled birth attendance among young women who had their first birth when they were adolescents could mean that this cohort of young women face some barriers in accessing maternal healthcare services.
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Affiliation(s)
- Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Vijay Kumar Chattu
- Department of Public Health, Saveetha Medical College and Hospitals, SIMATS, Saveetha University, Chennai, TN, 600077, India.,Department of Community Medicine, Faculty of Medicine, Datta Meghe Institute of Medical Sciences (Deemed University), Wardha, MS, 442107, India
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Abdul-Aziz Seidu
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia. .,Centre For Gender and Advocacy, Takoradi Technical University, P.O.Box 256, Takoradi, Ghana.
| | - Aliu Mohammed
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Justice Kanor Tetteh
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Francis Arthur-Holmes
- Department of Sociology and Social Policy, Lingnan University, 8 Castle Peak Road, Tuen Mun, Hong Kong
| | - Collins Adu
- Department of Health Promotion, Education and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada.,The George Institute for Global Health, Imperial College London, London, UK
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Brunton G, Wahab S, Sheikh H, Davis BM. Global stakeholder perspectives of home birth: a systematic scoping review. Syst Rev 2021; 10:291. [PMID: 34727980 PMCID: PMC8561961 DOI: 10.1186/s13643-021-01837-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022] Open
Abstract
Home birth is experienced by people very differently worldwide. These experiences likely differ by the type of stakeholder involved (women, their support persons, birth attendants, policy-makers), the experience itself (low-risk birth, transfer to hospital, previous deliveries), and by the health system within which home birth occurs (e.g., high-resource versus low- and middle-resource countries). Research evidence of stakeholders' perspectives of home birth could usefully inform personal and policy decisions about choosing and providing home birth, but the current literature is fragmented and its breadth is not fully understood.We conducted a systematic scoping review to understand how the research literature on stakeholders' perspectives of home birth is characterized in terms of populations, settings and identified issues, and what potential gaps exist in the research evidence. A range of electronic, web-based and key informant sources of evidence were searched. Located references were assessed, data extracted, and descriptively analyzed using robust methods.Our analysis included 460 full reports. Findings from 210 reports of studies in high-resource countries suggested that research with fathers and same-sex partners, midwives, and vulnerable populations and perspectives of freebirth and transfer to hospital could be synthesized. Gaps in primary research exist with respect to family members, policy makers, and those living in rural and remote locations. A further 250 reports of studies in low- and middle-resource countries suggested evidence for syntheses related to fathers and other family members, policy makers, and other health care providers and examination of issues related to emergency transfer to hospital, rural and remote home birth, and those who birth out of hospital, often at home, despite receiving antenatal care intended to increase healthcare-seeking behavior. Gaps in primary research suggest an examination is needed of perspectives in countries with higher maternal mortality and among first-time mothers and young mothers.Our scoping review identified a considerable body of research evidence on stakeholder perspectives of home birth. These could inform the complex factors influencing personal decisions and health system planning around home birth in both high- and low- and middle-resource countries. Future primary research is warranted on specific stakeholders worldwide and with vulnerable populations in areas of high maternal mortality.
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Affiliation(s)
- Ginny Brunton
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON Canada
| | - Samira Wahab
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON Canada
| | - Hassan Sheikh
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON Canada
| | - Beth Murray Davis
- McMaster Midwifery Research Centre, Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
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11
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Bam V, Lomotey AY, Kusi-Amponsah Diji A, Budu HI, Bamfo-Ennin D, Mireku G. Factors influencing decision-making to accept elective caesarean section: A descriptive cross-sectional study. Heliyon 2021; 7:e07755. [PMID: 34430742 PMCID: PMC8365447 DOI: 10.1016/j.heliyon.2021.e07755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/09/2021] [Accepted: 08/09/2021] [Indexed: 11/26/2022] Open
Abstract
Elective caesarean sections (CS) that have medical indications contribute to better pregnancy outcomes but women have to consent for the procedure to be performed within reasonable time limits for the desired outcomes. This study aimed to determine the factors that influence women's decision-making and the duration of the decision-making process to accept primary or repeat elective CS in a district hospital in Ghana. A descriptive cross-sectional study was conducted among 163 purposively-sampled postnatal women in a hospital, who had experienced a CS. A questionnaire was used to collect data after the women gave their consent to participate. Data was analyzed using SPSS version 25.0 and presented using appropriate descriptive statistics. Chi-square test of independence was done to determine the association between any two categorical variables. Major factors that influenced women's decision-making to accept elective CS were support from their husband/partner/relatives (39.3 %), their baby's life being at risk (24.5 %), history of previous CS and knowledge about the procedure (19.6 %). Age and parity had significant relationship with the influencing factors. However, age was only significant for the influence of husband/partner/relative in the decision-making to accept CS (p < 0.01). Age (R2 = 0.19, p < 0.001); previous CS (R2 = 0.14, p < 0.001) are the major predictors of the duration of the decision-making process. Women's decision-making in consultation with relatives is the main influencer to accept elective caesarean section. There is the need to involve relatives during the antenatal care period in order for younger women in particular to be readily supported to make timely decisions to avoid preventable complications and allay client's fears.
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Affiliation(s)
- Victoria Bam
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana
| | | | | | - Hayford Isaac Budu
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana
| | - Dorothy Bamfo-Ennin
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana
| | - Georgina Mireku
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Ghana
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12
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Yaya S, Zegeye B, Ahinkorah BO, Seidu AA, Ameyaw EK, Adjei NK, Shibre G. Predictors of skilled birth attendance among married women in Cameroon: further analysis of 2018 Cameroon Demographic and Health Survey. Reprod Health 2021; 18:70. [PMID: 33766075 PMCID: PMC7993505 DOI: 10.1186/s12978-021-01124-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/17/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND In Cameroon, maternal deaths remain high. The high maternal deaths in the country have been attributed to the low utilization of maternal healthcare services, including skilled birth attendance. This study examined the predictors of skilled birth services utilization among married women in Cameroon. METHODS Data from the 2018 Cameroon Demographic and Health Survey was analyzed on 7881 married women of reproductive age (15-49 years). Both bivariate and multivariable logistic regression analyses were carried out to determine the predictors of skilled childbirth services. The results were presented with crude odds ratio (cOR) and adjusted odds ratio (aOR) and 95% confidence interval (CI). RESULTS The coverage of skilled birth attendance among married women of reproductive age in Cameroon was 66.2%. After adjusting for potential confounders, media exposure (aOR = 1.46, 95% CI: 1.11-1.91), higher decision making (aOR = 1.88, 95% CI: 1.36-2.59), maternal education (aOR = 2.38, 95% CI; 1.65-3.42), place of residence (aOR = 0.50, 95% CI; 0.33-0.74), religion (aOR = 0.55, 95% CI; 0.35-0.87), economic status (aOR = 5.16, 95% CI; 2.58-10.30), wife beating attitude (aOR = 1.32, 95% CI; 1.05-1.65), parity (aOR = 0.62, 95% CI; 0.41-0.93) and skilled antenatal care (aOR = 14.46, 95% CI; 10.01-20.89) were found to be significant predictors of skilled birth attendance. CONCLUSIONS This study demonstrates that social, economic, regional, and cultural factors can act as barriers to skilled childbirth services utilization in Cameroon. Interventions that target women empowerment, antenatal care awareness and strengthening are needed, especially among the rural poor, to reduce barriers to care seeking. Maternal healthcare services utilization interventions and policies in Cameroon need to focus on specific equity gaps that relate to socio-economic status, maternal education, and the economic empowerment of women. Such policies and interventions should also aim at reducing geographical barriers to access to maternal healthcare services, including skilled birth attendance. Due to the presence of inequities in the use of skilled birth attendance services, programs aimed at social protection and empowerment of economically disadvantaged women are necessary for the achievement of the post-2015 targets and the Sustainable Development Goals. Globally, Cameroon is one of the countries with high maternal deaths. Low utilization of maternal healthcare services, including skilled birth attendance have been found to account for the high maternal deaths in the country. This study sought to examine the factors associated with skilled childbirth services utilization among married women in Cameroon. Using data from the 2018 Cameroon Demographic and Health Survey, we found that the coverage of skilled birth attendance among married women of reproductive age in Cameroon is high. Factors such as higher decision-making power, higher maternal education, place of residence, religion, higher economic status, wife beating attitude, parity and skilled antenatal care were found to be the significant predictors of skilled birth attendance. This study has shown that socio-economic, regional and cultural factors account for the utilization of skilled childbirth services utilization in Cameroon. Interventions aimed at enhancing the utilization of skilled childbirth services in Cameroon should target women empowerment, antenatal care awareness creation and sensitization, especially among the rural poor, to reduce barriers to care seeking. Maternal healthcare services utilization interventions and policies in Cameroon need to focus on specific equity gaps that relate to socio-economic status, maternal education, and the economic empowerment of women.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, Imperial College London, London, UK
| | - Betregiorgis Zegeye
- HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, Ethiopia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Nicholas Kofi Adjei
- Leibniz Institute for Prevention Research and Epidemiology, BIPS, Heiligenhafen, Germany
| | - Gebretsadik Shibre
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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13
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Loll D, Fleming PJ, Stephenson R, King EJ, Morhe E, Manu A, Hall KS. Factors associated with reproductive autonomy in Ghana. CULTURE, HEALTH & SEXUALITY 2021; 23:349-366. [PMID: 32301400 DOI: 10.1080/13691058.2019.1710567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 12/27/2019] [Indexed: 06/11/2023]
Abstract
Reproductive autonomy is essential for women to achieve reproductive rights and freedom. However, the factors associated with reproductive autonomy in various contexts have not been explored. The aim of this analysis was to understand the socio-demographic, reproductive history and social context variables associated with two validated reproductive autonomy sub-scales among 516 young Ghanaian women age 15 to 24. We used multiple linear regression modelling to test associations between covariates of interest and the communication sub-scale and decision-making sub-scale. Covariates included age, educational attainment, ethnic group, employment, religion, religious attendance, relationship type, previous pregnancy, previous abortion, social support for adolescent sexual and reproductive health, and social stigma towards adolescent sexual and reproductive health. Results from final models demonstrated that factors associated with the communication scale included education (p = 0.008), ethnic group (p = 0.039), and social support for adolescent sexual and reproductive health (B = 0.12, p = 0.003). Factors associated with the decision-making scale included ethnic group (p = 0.002), religion (p = 0.003), religious attendance (p = 0.043), and previous pregnancy (p = 0.008). Communication reproductive autonomy and decision-making reproductive autonomy were associated with different factors, providing insight into potential intervention approaches and points. Social support for adolescent sexual and reproductive health was associated with increases in young women's abilities to communicate with their partners about sexual and reproductive health issues including sex, contraceptive use and fertility.
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Affiliation(s)
- Dana Loll
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Paul J Fleming
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Rob Stephenson
- Department of Systems, Population, and Leadership, School of Nursing, Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth J King
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Emmanuel Morhe
- Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Adom Manu
- Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Kelli Stidham Hall
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Kumbeni MT, Apanga PA. Institutional delivery and associated factors among women in Ghana: findings from a 2017-2018 multiple indicator cluster survey. Int Health 2021; 13:520-526. [PMID: 33539526 PMCID: PMC8643427 DOI: 10.1093/inthealth/ihab002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/29/2020] [Accepted: 01/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background Institutional delivery is essential in reducing maternal morbidity and mortality. We investigated the prevalence of institutional delivery and associated factors among women in Ghana. Methods National representative data from the 2017–2018 Ghana Multiple Indicator Cluster Survey was used for the analysis. The study included 3466 women, ages 15–49 y, who had a live birth in the last 2 y. Descriptive statistics were used to assess the prevalence of institutional delivery while multivariate logistic regression was used to assess the relationship between our variables of interest and institutional delivery. Results The prevalence of institutional delivery among women in Ghana was 77.89% (95% confidence interval [CI] 75.29 to 80.50). High-income households (adjusted odds ratio [aOR] 2.13 [95% CI 1.36 to 3.35]), attending antenatal care at least four times (aOR 2.37 [95% CI 1.54 to 3.65]) and knowing one's human immunodeficiency virus status (aOR 1.41 [95% CI 1.08 to 1.84]) were associated with higher odds of institutional delivery. Living in rural areas (aOR 0.43 [95% CI 0.27 to 0.67]), multiparity (aOR 0.59 [95% CI 0.41 to 0.85]) and no health insurance (aOR 0.57 [95% CI 0.44 to 0.74]) were associated with lower odds of institutional delivery. Conclusions The government of Ghana may need to focus on increasing health insurance utilization and antenatal care attendance in order to increase the coverage of institutional delivery.
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Affiliation(s)
- Maxwell T Kumbeni
- Ghana Health Service, Nabdam District Health Directorate, Nangodi, Ghana
| | - Paschal A Apanga
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
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15
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Sougou NM, Sougou AS, Bassoum O, Lèye MMM, Faye A, Seck I. Facteurs associés à l’autonomie de décision des femmes pour leur santé au Sénégal. SANTE PUBLIQUE 2021; 32:381-388. [PMID: 33512105 DOI: 10.3917/spub.204.0381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION In Senegal, the issue of access to maternal, reproductive and sexual health services remains a health priority. Although there have been many health interventions, women’s access to health services remains limited due to women’s limited autonomy in making decisions about their health.Purpose of research: The objective of this study was to study the factors associated with women’s decision-making autonomy in relation to their own health in Senegal in 2017. RESULTS Six-point twenty-six percent (6.26%) of women were autonomous in making decisions about their health. For 80.33% of women, it was their husband or partner who decided for them.The factors associated with women’s decision-making autonomy were the 20-24 and 45-49 age groups with AOR of 0.28 [0.10-0.77] and 2.99 [1.25-7.17], rural housing environment (AOR = 0.52 [0.34-0.80]), higher women’s level of education (AOR = 4.10 [1.54-10.93]), the level of education of the husband/primary partner (AOR = 1.98 [1.08-3.61]), the marital status of the married woman (AOR = 0.09 [0.02-0.38]) and the fact that the woman is engaged in an income-generating activity (AOR = 3.70 [2.52-5.44]). CONCLUSIONS This study highlights a low rate of decision-making autonomy among Senegalese women. It also made it possible to identify the factors on which action should be taken to improve women’s decision-making autonomy for their health. These factors include women’s access to education and the promotion of income-generating activities among women.
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16
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Zhang Z, Cunningham K, Adhikari RP, Yogi S, Manandhar S, Rana PP, Paxton A. Maternal Decision-Making Input and Health-Seeking Behaviors Between Pregnancy and the Child's Second Birthday: A Cross-Sectional Study in Nepal. Matern Child Health J 2020; 24:1121-1129. [PMID: 32557134 PMCID: PMC7419350 DOI: 10.1007/s10995-020-02961-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Maternal health-seeking behaviors are critical to improving maternal and child health in low-income countries. This study investigates associations between maternal decision-making input and their health-seeking behaviors in the first 1000-day period between pregnancy and a child's second birthday in Nepal. METHODS We used data from a cross-sectional survey conducted in 2018 in 16 districts of Nepal. Among the 3648 households surveyed, 1910 mothers of a child 0 to 24 months with complete data were included for analyses. Logistic regression was used to examine associations between decision-making input and the utilization of antenatal, delivery and postnatal care services, and attendance at health mothers' group (HMG) meetings. We also used negative binomial regression to assess the relationship between her decision-making input and participation in growth monitoring and promotion (GMP) in the 6 months prior to the survey. For each relationship examined, we adjusted for clustering, as well as potentially confounding factors at individual and household levels. RESULTS After adjusting for confounders, maternal decision-making input had a small but positive and significant association with receiving at least 4 antenatal care visits (OR = 1.09, 95% CI 1.02, 1.17), attendance at GMP in the 6 months prior to the survey (IRR = 1.02, 95% CI 1.00, 1.04), and HMG attendance (OR = 1.10, 95% CI 1.03, 1.17), but not with receiving at least 3 postnatal care visits or delivering in a health institution. CONCLUSIONS FOR PRACTICE Our findings indicated that empowering women and mothers in household decision-making might warrant greater attention when developing future policies and programs in Nepal.
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Affiliation(s)
- Zhongjie Zhang
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Helen Keller International, Kathmandu, Nepal
| | | | | | - Subash Yogi
- Helen Keller International, Kathmandu, Nepal
- CARE, Kathmandu, Nepal
| | | | | | - Anne Paxton
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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17
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Sougou NM, Bassoum O, Faye A, Leye MMM. Women's autonomy in health decision-making and its effect on access to family planning services in Senegal in 2017: a propensity score analysis. BMC Public Health 2020; 20:872. [PMID: 32503492 PMCID: PMC7275346 DOI: 10.1186/s12889-020-09003-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background The effect of women’s autonomy in decision-making for fertility control has been highlighted by research. The objective of this study was to analyze the effect of women’s autonomy over decision-making regarding their health and access to family planning in Senegal in 2017. Methods The analyses in this study were carried out using data from the Senegal Demographic and Health Survey in 2017. The sample consisted of 8865 women aged 15–49. The propensity score-matching method was applied. Autonomy in health decision-making was considered the treatment variable. Matching was performed using confounding variables. The outcome variables were the current use of modern contraceptive methods and the existence of unmet needs. The common support condition had been met. The analysis was conducted using STATA.15 software. Results This study showed that 6.26% of women had decision-making autonomy in relation to their health. For 80.33% of the women, their husbands/partners made health-related decisions for them. Decision-making autonomy increased significantly with the age of the woman (p < 0.05). In addition, 15.24% of women were using a modern method of contraception. An estimated 26.2% of women had unmet needs. Propensity score matching split the women into two groups based on autonomy over decision-making for their health. After matching, there was no longer a significant difference between women who were autonomous with respect to their decision-making and those who were not autonomous with respect to their current use of a modern contraceptive method. On the other hand, there was a 14.42% reduction (p < 0.05) in unmet needs for family planning in the group of women who were autonomous with respect to their health decision-making. Conclusion Autonomy in health decision-making would reduce unmet needs among Senegalese women. These results show the importance of accounting for gender in health interventions for the accessibility of family planning services.
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Affiliation(s)
- N M Sougou
- Department of Preventive Medicine and Public Health, University of Cheikh Anta Diop, Dakar, Senegal. .,Institute of Health Development, University of Cheikh Anta Diop, Dakar, Senegal. .,UMI 3189 « Environnement, Santé, Sociétés », UCAD, CNRS, CNRST, USTTB, UGB, Dakar, Senegal.
| | - O Bassoum
- Department of Preventive Medicine and Public Health, University of Cheikh Anta Diop, Dakar, Senegal
| | - A Faye
- Department of Preventive Medicine and Public Health, University of Cheikh Anta Diop, Dakar, Senegal.,Institute of Health Development, University of Cheikh Anta Diop, Dakar, Senegal
| | - M M M Leye
- Department of Preventive Medicine and Public Health, University of Cheikh Anta Diop, Dakar, Senegal.,Institute of Health Development, University of Cheikh Anta Diop, Dakar, Senegal
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Ketemaw A, Tareke M, Dellie E, Sitotaw G, Deressa Y, Tadesse G, Debalkie D, Ewunetu M, Alemu Y, Debebe D. Factors associated with institutional delivery in Ethiopia: a cross sectional study. BMC Health Serv Res 2020; 20:266. [PMID: 32234043 PMCID: PMC7106663 DOI: 10.1186/s12913-020-05096-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 03/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In spite of the promotion of institutional delivery in Ethiopia, home delivery is still common primarily in hard-to-reach areas. Institutional delivery supported to achieve the goal of reducing maternal and neonatal mortality in Ethiopia. The objective of this study is to assess the determinants of institutional delivery in Ethiopia. METHODS Cross sectional survey was conducted in 11 administrative regions of Ethiopia. The Ethiopian demographic and health survey data collection took place from January 18, 2016, to June 27, 2016. The study subjects were 11,023 women (15-49 years old) who gave birth in the preceding 5 years before 2016 Ethiopian demographic health survey. This representative data was downloaded from Demographic Health Survey after getting permission. The Primary outcome variable was institutional delivery. The data was transferred and analyzed with SPSS Version 20 statistical software package. RESULTS Of 11,023 mothers, 2892 (26.2%) delivered at a health facility and 8131 (73.8%) at home. Women with secondary education were 4.36 times more likely to have an institutional delivery (OR: 4.36; 95% CI: 3.12-6.09). Institutional delivery was higher among women who were resided in urban areas by three fold (OR: 3.26; 95% CI: 2.19-4.35). Women who visited ANC (Antenatal care) were about two times more likely to choose institutional delivery (OR: 1.81; 95% CI: 1.58-2.07). Respondents who watch television at least once a week was two times more likely to experience institutional delivery than those who did not watch at all (0R: 1.90; 95% CI: 1.35-2.66). The wealthiest women were 2.61 times more likely to deliver in an institution compared with the women in the poorest category (OR: 2.61; 95% CI: 1.95-3.50). CONCLUSION Women having higher educational level, being richest, residing in urban area, visiting antenatal care at least once, and frequent exposure to mass media were factors associated with institutional delivery. Improving access to education and health promotion about obstetrics and delivery through mass media will increase the uptake of institutional delivery.
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Affiliation(s)
- Asmamaw Ketemaw
- School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Minale Tareke
- School of Medicine, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Endalkachew Dellie
- Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Getachew Sitotaw
- School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yonas Deressa
- School of Medicine, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Getasew Tadesse
- School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Desta Debalkie
- School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Mesafinet Ewunetu
- School of Medicine, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yibeltal Alemu
- School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Daniel Debebe
- Bahir Dar Institute of Technology, Bahir Dar University, Bahir Dar, Ethiopia
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Dugle G, Akanbang BAA, Abiiro GA. Exploring factors influencing adverse birth outcomes in a regional hospital setting in Ghana: A configuration theoretical perspective. Women Birth 2020; 34:187-195. [PMID: 32098721 DOI: 10.1016/j.wombi.2020.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/16/2020] [Accepted: 02/16/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Understanding the complexity of factors that influence adverse childbirth outcomes at health facilities can be enhanced by the theoretical articulation of the interplay between external socio-structural and internal technical dynamics of the birthplace in context. Guided by configuration theory, this study explored the factors that influence adverse birth outcomes at a regional hospital setting in Ghana. METHODS Qualitative data were collected from the Upper West regional hospital in Ghana. In-depth interviews were administered to 30 purposively selected respondents comprising 20 postpartum mothers and 10 midwives. The data was electronically audio-recorded, transcribed and analysed using thematic analysis. FINDINGS The study revealed three key dimensions of socio-technical configurations shaping adverse birth outcomes within the hospital setting. These are mother-midwife personality and behavioral dynamics including personality clashes and poor communication; birth process dynamics consisting of diverse paradigms of safe birthing process and socio-technical conflicts on caesarean section; and birthplace context, comprising nature of the birthing environment, confidence in the safety of the birthplace and national health policy implementation challenges. These socio-technical interactions result in late reporting at facilities by mothers and delay in care delivery by midwives, contributing to adverse birth outcomes. CONCLUSION In line with configuration theory, our study positions the influences of adverse birth outcomes in hospital settings in alignment with a subtle and iterative interplay of socio-technical factors. To comprehensively address adverse birth outcomes in hospital settings, health policymakers and practitioners need to understand and contextualise the socio-technical interactions that shape notable outcomes at specific hospital settings.
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Affiliation(s)
- Gordon Dugle
- Department of Management Studies, School of Business and Law, University for Development Studies, Wa Campus, Ghana; Nottingham University Business School, Jubilee Campus, Nottingham, NG8 1BB, UK.
| | | | - Gilbert Abotisem Abiiro
- Department of Planning, Faculty of Planning and Land Management, University for Development Studies, Wa Campus, Ghana
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Olakunde BO, Adeyinka DA, Mavegam BO, Olakunde OA, Yahaya HB, Ajiboye OA, Ogundipe T, Ezeanolue EE. Factors associated with skilled attendants at birth among married adolescent girls in Nigeria: evidence from the Multiple Indicator Cluster Survey, 2016/2017. Int Health 2020; 11:545-550. [PMID: 30990520 DOI: 10.1093/inthealth/ihz017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/05/2019] [Accepted: 03/05/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study examines the factors associated with skilled birth attendants at delivery among married adolescent girls in Nigeria. METHODS The study was a secondary data analysis of the fifth round of the Multiple Indicator Cluster Survey conducted between September 2016 and January 2017. Married adolescent girls aged 15-19 y who had live births in the last 2 y preceding the survey were included in the analysis. We performed univariate and multivariate logistic regression analyses with a skilled birth attendant (doctor, nurse or midwife) at delivery as the outcome variable and sociodemographic, male partner- and maternal health-related factors as explanatory variables. RESULTS Of the 789 married adolescent girls, 387 (27% [95% CI=22.8-30.7]) had a skilled birth attendant at delivery. In the adjusted model, adolescent girls who were aged ≥18 y (ref: <18 y), primiparous (ref: multiparous), had antenatal care (ANC) provided by skilled healthcare providers (ref: no ANC), belonged to at least the poor and middle wealth index quintiles (ref: poorest), and resided in the south west zone (ref: north central), independently had a significantly higher likelihood of having a skilled birth attendant at delivery. CONCLUSIONS Interventions that will reduce pregnancy in younger adolescent girls, poverty, and increase ANC provided by skilled attendants, are likely to improve deliveries assisted by skilled birth attendants among married adolescent girls in Nigeria.
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Affiliation(s)
- Babayemi O Olakunde
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Plot 823, Ralph Shodeinde Street, Central Business District, Abuja, Nigeria
| | - Daniel A Adeyinka
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada.,National AIDS & STIs Control Programme, Federal Ministry of Health, Abuja, Nigeria
| | - Bertille O Mavegam
- Department of Environmental and Occupational Health, School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA
| | - Olubunmi A Olakunde
- Department of Disease Control and Immunization, Ondo State Primary Health Care Development Board, Ondo, Nigeria
| | - Hidayat B Yahaya
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Plot 823, Ralph Shodeinde Street, Central Business District, Abuja, Nigeria
| | - Oluwatosin A Ajiboye
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Plot 823, Ralph Shodeinde Street, Central Business District, Abuja, Nigeria
| | - Temitayo Ogundipe
- Department of Community and Family Medicine, Howard University Hospital, Washington DC, USA
| | - Echezona E Ezeanolue
- Department of Pediatrics and Child Health, University of Nigeria, Nsukka, Enugu, Nigeria.,HealthySunrise Foundation, Las Vegas, NV, USA
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Garcia-Elorrio E, Rowe SY, Teijeiro ME, Ciapponi A, Rowe AK. The effectiveness of the quality improvement collaborative strategy in low- and middle-income countries: A systematic review and meta-analysis. PLoS One 2019; 14:e0221919. [PMID: 31581197 PMCID: PMC6776335 DOI: 10.1371/journal.pone.0221919] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 08/16/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Quality improvement collaboratives (QICs) have been used to improve health care for decades. Evidence on QIC effectiveness has been reported, but systematic reviews to date have little information from low- and middle-income countries (LMICs). OBJECTIVE To assess the effectiveness of QICs in LMICs. METHODS We conducted a systematic review following Cochrane methods, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach for quality of evidence grading, and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement for reporting. We searched published and unpublished studies between 1969 and March 2019 from LMICs. We included papers that compared usual practice with QICs alone or combined with other interventions. Pairs of reviewers independently selected and assessed the risk of bias and extracted data of included studies. To estimate strategy effectiveness from a single study comparison, we used the median effect size (MES) in the comparison for outcomes in the same outcome group. The primary analysis evaluated each strategy group with a weighted median and interquartile range (IQR) of MES values. In secondary analyses, standard random-effects meta-analysis was used to estimate the weighted mean MES and 95% confidence interval (CI) of the mean MES of each strategy group. This review is registered with PROSPERO (International Prospective Register of Systematic Reviews): CRD42017078108. RESULTS Twenty-nine studies were included; most (21/29, 72.4%) were interrupted time series studies. Evidence quality was generally low to very low. Among studies involving health facility-based health care providers (HCPs), for "QIC only", effectiveness varied widely across outcome groups and tended to have little effect for patient health outcomes (median MES less than 2 percentage points for percentage and continuous outcomes). For "QIC plus training", effectiveness might be very high for patient health outcomes (for continuous outcomes, median MES 111.6 percentage points, range: 96.0 to 127.1) and HCP practice outcomes (median MES 52.4 to 63.4 percentage points for continuous and percentage outcomes, respectively). The only study of lay HCPs, which used "QIC plus training", showed no effect on patient care-seeking behaviors (MES -0.9 percentage points), moderate effects on non-care-seeking patient behaviors (MES 18.7 percentage points), and very large effects on HCP practice outcomes (MES 50.4 percentage points). CONCLUSIONS The effectiveness of QICs varied considerably in LMICs. QICs combined with other invention components, such as training, tended to be more effective than QICs alone. The low evidence quality and large effect sizes for QIC plus training justify additional high-quality studies assessing this approach in LMICs.
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Affiliation(s)
- Ezequiel Garcia-Elorrio
- Healthcare quality and safety department, Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Samantha Y. Rowe
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- CDC Foundation, Atlanta, Georgia, United States of America
| | - Maria E. Teijeiro
- Quality Department, Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLENI), Escobar, Buenos Aires Province, Argentina
| | - Agustín Ciapponi
- Argentine Cochrane Centre, Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Alexander K. Rowe
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Greenspan JA, Chebet JJ, Mpembeni R, Mosha I, Mpunga M, Winch PJ, Killewo J, Baqui AH, McMahon SA. Men's roles in care seeking for maternal and newborn health: a qualitative study applying the three delays model to male involvement in Morogoro Region, Tanzania. BMC Pregnancy Childbirth 2019; 19:293. [PMID: 31409278 PMCID: PMC6693212 DOI: 10.1186/s12884-019-2439-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 07/29/2019] [Indexed: 01/08/2023] Open
Abstract
Background Increasing the utilization of facility-based care for women and newborns in low-resource settings can reduce maternal and newborn morbidity and mortality. Men influence whether women and newborns receive care because they often control financial resources and household decisions. This influence can have negative effects if men misjudge or ignore danger signs or are unwilling or unable to pay for care. Men can also positively affect their families’ health by helping plan for delivery, supplementing women’s knowledge about danger signs, and supporting the use of facility-based care. Because of these positive implications, researchers have called for increased male involvement in maternal and newborn health. However, data gathered directly from men to inform programs are lacking. Methods This study draws on in-depth interviews with 27 men in Morogoro Region, Tanzania whose partners delivered in the previous 14 months. Debriefings took place throughout data collection. Interview transcripts were analyzed inductively to identify relevant themes and devise an analysis questionnaire, subsequently applied deductively to all transcripts. Results Study findings add a partner-focused dimension to the three delays model of maternal care seeking. Men in the study often, though not universally, described facilitating access to care for women and newborns at each point along this care-seeking continuum (deciding to seek care, reaching a facility, and receiving care). Specifically, men reported taking ownership of their role as decision makers and described themselves as supportive of facility-based care. Men described arranging transport and accompanying their partners to facilities, especially for non-routine care. Men also discussed purchasing supplies and medications, acting as patient advocates, and registering complaints about health services. In addition, men described barriers to their involvement including a lack of knowledge, the need to focus on income-generating activities, the cost of care, and policies limiting male involvement at facilities. Conclusion Men can leverage their influence over household resources and decision making to facilitate care seeking and navigate challenges accessing care for women and newborns. Examining these findings from men and understanding the barriers they face can help inform interventions that encourage men to be positively and proactively involved in maternal and newborn health.
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Affiliation(s)
- Jesse A Greenspan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, USA.,Partners In Health, 800 Boylston Street, Suite 300, Boston, MA, USA
| | - Joy J Chebet
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, USA.,Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Rose Mpembeni
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar-Es-Salaam, Tanzania.
| | - Idda Mosha
- Department of Behavioural Sciences, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar-Es-Salaam, Tanzania
| | - Maurus Mpunga
- Department of Labour Studies, Institute of Social Work, P.O. Box 3375, Dar-es-Salaam, Tanzania
| | - Peter J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, USA
| | - Japhet Killewo
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar-Es-Salaam, Tanzania
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, USA
| | - Shannon A McMahon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, USA.,Institute of Public Health, Ruprecht-Karls-Universität, Heidelberg, Germany
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Sumankuuro J, Mahama MY, Crockett J, Wang S, Young J. Narratives on why pregnant women delay seeking maternal health care during delivery and obstetric complications in rural Ghana. BMC Pregnancy Childbirth 2019; 19:260. [PMID: 31337348 PMCID: PMC6651920 DOI: 10.1186/s12884-019-2414-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 07/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the many maternal healthcare policy programmes in Ghana such as free the antenatal care (ANC) and the fee-exemption policy under the National Health Insurance Scheme, among others, the country has yet to make substantial improvements in addressing low skilled care utilisation in pregnancy and delivery. From previous studies, maternal mortality has been linked to women's healthcare decision-making power at the household level in many low and middle-income countries. Thus, a pregnant women's ability to choose a healthcare provider, act on her preferences, and to be sufficiently financially empowered to take the lead in deciding on reproductive and pregnancy care has significant effects on service utilisation outcomes. Therefore, we explored rural community-level barriers to seeking care related to obstetric complications and delivery from the perspectives of mothers, youth, opinion leaders and healthcare providers in Nadowli-Kaleo and Daffiama-Bussie-Issa districts in the Upper West Region of Ghana. METHODS This exploratory qualitative study was based on the narratives of women, health providers and community stakeholders regarding the expectant women's autonomy to decide and utilise maternal care. To achieve maximal diversity of responses, purposive sampling procedures were followed in selecting 16 health professionals, three traditional birth attendants and 240 community members (opinion leaders, youth and non-pregnant women) who participated in individual depth interviews and focus group discussions. RESULTS Women's lack of autonomy to seek care without prior permission, perceived quality care of traditional birth attendants, stigmatisation of unplanned pregnancies and cultural beliefs associated with late disclosure of childbirth labour all delayed mothers timely use of skilled care in the study communities. These barriers compounded problems arising from communities that are geographically isolated from hospital care. CONCLUSIONS Decisions about seeking maternal care were usually made by the expectant woman's husband and family without providing adequate support to pregnant women during the latter stages of pregnancy and delivery. We conclude that this is primarily a cultural issue. The study recommends a change in the approach to community-level health education campaigns for maximum impacts through the increased involvement of men and families in health service delivery and utilisation.
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Affiliation(s)
- Joshua Sumankuuro
- Youth Alive Ghana, P.O Box TL 1708, Tamale, Ghana. .,School of Community Health, Faculty of Science, Charles Sturt University, Orange, NSW, Australia.
| | - Memuna Yankasa Mahama
- Department of Health Education, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Judith Crockett
- School of Community Health, Faculty of Science, Charles Sturt University, Orange, NSW, Australia
| | - Shaoyu Wang
- School of Community Health, Faculty of Science, Charles Sturt University, Orange, NSW, Australia
| | - Jeanine Young
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Brisbane, Queensland, Australia
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Zhang C, Rahman MS, Rahman MM, Yawson AE, Shibuya K. Trends and projections of universal health coverage indicators in Ghana, 1995-2030: A national and subnational study. PLoS One 2019; 14:e0209126. [PMID: 31116754 PMCID: PMC6530887 DOI: 10.1371/journal.pone.0209126] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 04/30/2019] [Indexed: 11/18/2022] Open
Abstract
Ghana has made significant stride towards universal health coverage (UHC) by implementing the National Health Insurance Scheme (NHIS) in 2003. This paper investigates the progress of UHC indicators in Ghana from 1995 to 2015 and makes future predictions up to 2030 to assess the probability of achieving UHC targets. National representative surveys of Ghana were used to assess health service coverage and financial risk protection. The analyses estimated the coverage of 13 prevention and four treatment service indicators at the national level and across wealth quintiles. In addition, we calculated catastrophic health payments and impoverishment to assess financial hardship and used a Bayesian regression model to estimate trends and future projections as well as the probabilities of achieving UHC targets by 2030. Wealth-based inequalities and regional disparities were also assessed. At the national level, 14 out of the 17 health service indicators are projected to reach the target of 80% coverage by 2030. Across wealth quintiles, inequalities were observed amongst most indicators with richer groups obtaining more coverage than their poorer counterparts. Subnational analysis revealed while all regions will achieve the 80% coverage target with high probabilities for the prevention services, the same cannot be applied to the treatment services. In 2015, the proportion of households that suffered catastrophic health payments and impoverishment at a threshold of 25% non-food expenditure were 1.9% (95%CrI: 0.9-3.5) and 0.4% (95%CrI: 0.2-0.8), respectively. These are projected to reduce to 0.4% (95% CrI: 0.1-1.3) and 0.2% (0.0-0.5) respectively by 2030. Inequality measures and subnational assessment revealed that catastrophic expenditure experienced by wealth quintiles and regions are not equal. Significant improvements were seen in both health service coverage and financial risk protection over the years. However, inequalities across wealth quintiles and regions continue to be cause of concerns. Further efforts are needed to narrow these gaps.
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Affiliation(s)
- Cherri Zhang
- Department of Global Health Policy, The University of Tokyo, Tokyo, Japan
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
| | - Md. Shafiur Rahman
- Department of Global Health Policy, The University of Tokyo, Tokyo, Japan
- Global Public Health Research Foundation, Dhaka, Bangladesh
| | - Md. Mizanur Rahman
- Department of Global Health Policy, The University of Tokyo, Tokyo, Japan
- Global Public Health Research Foundation, Dhaka, Bangladesh
| | - Alfred E. Yawson
- Department of Community Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Kenji Shibuya
- Department of Global Health Policy, The University of Tokyo, Tokyo, Japan
- University Institute for Population Health, King’s College London, London, United Kingdom
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25
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Asefa A, Gebremedhin S, Messele T, Letamo Y, Shibru E, Alano A, Morgan A, Kermode M. Mismatch between antenatal care attendance and institutional delivery in south Ethiopia: A multilevel analysis. BMJ Open 2019; 9:e024783. [PMID: 30898814 PMCID: PMC6527994 DOI: 10.1136/bmjopen-2018-024783] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Uptake of maternal health services remains suboptimal in Ethiopia. Significant proportions of antenatal care attendees give birth at home. This study was conducted to identify the predictors of non-institutional delivery among women who received antenatal care in the Southern Nations Nationalities and Peoples Region, Ethiopia. DESIGN A community-based cross-sectional survey was conducted among women who delivered in the year preceding the survey and who had at least one antenatal visit. Multistage cluster sampling was deployed to select 2390 women from all administrative zones of the region. A mixed-effects multivariable logistic regression analysis was performed to assess the predictors of non-institutional delivery; adjusted ORs (AOR) with 95% CIs are reported. RESULTS The proportion of non-institutional deliveries among participants was 62.2% (95% CI 60.2% to 64.2%). Previous experience of short and simple labour (46.9%) and uncomplicated home birth (42.9%), night-time labour (29.7%), absence of pregnancy-related problem (18.8%) and perceived providers poor reception of women (17.8%) were the main reasons to have non-institutional delivery. Attending secondary school and above (AOR=0.51; 95% CI 0.30 to 0.85), being a government employee (AOR=0.27; 95% CI 0.10 to 0.78) and woman's autonomy in healthcare utilisation decision making (AOR=0.51; 95% CI 0.33 to 0.79) were among the independent predictors negatively associated with non-institutional delivery. On the other hand, unplanned pregnancy (AOR=1.67; 95% CI 1.16 to 2.42), not experiencing any health problem during pregnancy (AOR=8.1; 95% CI 3.12 to 24.62), not perceiving the risks associated with home delivery (AOR=6.64; 95% CI 4.35 to 10.14) were the independent predictors positively associated with non-institutional delivery. CONCLUSIONS There is a missed opportunity among women attending antenatal care in southern Ethiopia. Further health system innovations that help to bridge the gap between antenatal care attendance and institutional delivery are highly recommended.
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Affiliation(s)
- Anteneh Asefa
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Samson Gebremedhin
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Tamiru Messele
- Southern Nations Nationalities and Peoples Region Health Bureau, Hawassa, Ethiopia
| | - Yohannes Letamo
- Southern Nations Nationalities and Peoples Region Health Bureau, Hawassa, Ethiopia
| | - Endashaw Shibru
- Southern Nations Nationalities and Peoples Region Health Bureau, Hawassa, Ethiopia
| | - Abraham Alano
- Southern Nations Nationalities and Peoples Region Health Bureau, Hawassa, Ethiopia
| | - Alison Morgan
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Michelle Kermode
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Serbanescu F, Goodwin MM, Binzen S, Morof D, Asiimwe AR, Kelly L, Wakefield C, Picho B, Healey J, Nalutaaya A, Hamomba L, Kamara V, Opio G, Kaharuza F, Blanton C, Luwaga F, Steffen M, Conlon CM. Addressing the First Delay in Saving Mothers, Giving Life Districts in Uganda and Zambia: Approaches and Results for Increasing Demand for Facility Delivery Services. GLOBAL HEALTH: SCIENCE AND PRACTICE 2019; 7:S48-S67. [PMID: 30867209 PMCID: PMC6519679 DOI: 10.9745/ghsp-d-18-00343] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 01/29/2019] [Indexed: 11/24/2022]
Abstract
The Saving Mothers, Giving Life initiative used 3 coordinated approaches to reduce
maternal deaths resulting from a delay in deciding to seek health care, known as the
“first delay”: (1) promoting safe motherhood messages and facility delivery
using radio, theater, and community engagement; (2) encouraging birth preparedness and
increasing demand for facility delivery through community outreach worker visits; and (3)
providing clean delivery kits and transportation vouchers to reduce financial barriers for
facility delivery. These approaches can be adapted in other low-resource settings to
reduce maternal and perinatal mortality. Saving Mothers, Giving Life (SMGL), a 5-year initiative implemented in selected districts
in Uganda and Zambia, was designed to reduce deaths related to pregnancy and childbirth by
targeting the 3 delays to receiving appropriate care at birth. While originally the
“Three Delays” model was designed to focus on curative services that
encompass emergency obstetric care, SMGL expanded its application to primary and secondary
prevention of obstetric complications. Prevention of the “first delay”
focused on addressing factors influencing the decision to seek delivery care at a health
facility. Numerous factors can contribute to the first delay, including a lack of birth
planning, unfamiliarity with pregnancy danger signs, poor perceptions of facility care,
and financial or geographic barriers. SMGL addressed these barriers through community
engagement on safe motherhood, public health outreach, community workers who identified
pregnant women and encouraged facility delivery, and incentives to deliver in a health
facility. SMGL used qualitative and quantitative methods to describe intervention
strategies, intervention outcomes, and health impacts. Partner reports, health facility
assessments (HFAs), facility and community surveillance, and population-based mortality
studies were used to document activities and measure health outcomes in SMGL-supported
districts. SMGL's approach led to unprecedented community outreach on safe motherhood
issues in SMGL districts. About 3,800 community health care workers in Uganda and 1,558 in
Zambia were engaged. HFAs indicated that facility deliveries rose significantly in SMGL
districts. In Uganda, the proportion of births that took place in facilities rose from
45.5% to 66.8% (47% increase); similarly, in Zambia SMGL districts,
facility deliveries increased from 62.6% to 90.2% (44% increase). In
both countries, the proportion of women delivering in facilities equipped to provide
emergency obstetric and newborn care also increased (from 28.2% to 41.0% in
Uganda and from 26.0% to 29.1% in Zambia). The districts documented declines
in the number of maternal deaths due to not accessing facility care during pregnancy,
delivery, and the postpartum period in both countries. This reduction played a significant
role in the decline of the maternal mortality ratio in SMGL-supported districts in Uganda
but not in Zambia. Further work is needed to sustain gains and to eliminate preventable
maternal and perinatal deaths.
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Affiliation(s)
- Florina Serbanescu
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Mary M Goodwin
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susanna Binzen
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Diane Morof
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.,U.S. Public Health Service Commissioned Corps, Rockville, MD, USA
| | - Alice R Asiimwe
- Baylor College of Medicine Children's Foundation-Uganda, Kampala, Uganda
| | - Laura Kelly
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA. Now with Deloitte Consulting, LLP, Atlanta, GA, USA
| | | | - Brenda Picho
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jessica Healey
- U.S. Agency for International Development, Lusaka, Zambia. Now based in Monrovia, Liberia
| | - Agnes Nalutaaya
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Leoda Hamomba
- Division of Global HIV and TB, Centers for Disease Control and Prevention-Zambia, Lusaka, Zambia
| | - Vincent Kamara
- Baylor College of Medicine Children's Foundation-Uganda, Kampala, Uganda
| | - Gregory Opio
- Infectious Diseases Institute, Makerere University, Kibaale, Uganda
| | - Frank Kaharuza
- Bureau for Global Health, U.S. Agency for International Development, Washington, DC, USA
| | - Curtis Blanton
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Fredrick Luwaga
- Baylor College of Medicine Children's Foundation-Uganda, Kampala, Uganda
| | - Mona Steffen
- Bureau for Global Health, U.S. Agency for International Development, Washington, DC. Now with ICF, Rockville, MD, USA
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Adu J, Tenkorang E, Banchani E, Allison J, Mulay S. The effects of individual and community-level factors on maternal health outcomes in Ghana. PLoS One 2018; 13:e0207942. [PMID: 30496236 PMCID: PMC6264832 DOI: 10.1371/journal.pone.0207942] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/08/2018] [Indexed: 11/23/2022] Open
Abstract
Background Utilization of maternal health care services is key to reducing the number of perinatal deaths and post-natal complications in sub-Saharan Africa. With a few exceptions, many studies that examine the use of maternal health services in sub-Saharan Africa have focused largely on individual-level explanations and have ignored the importance of contextual and community-level explanations. In Ghana, progress has been made in reducing maternal mortality ratio from 740/100,000 in the late 1990s to 319/100,000 in 2015 but these rates are still high. Our study focuses on impact of individual and community level-factors on maternal outcomes with the hope that it will inform public policy in Ghana. This approach highlights latent or unacknowledged aspects of fragility within health systems designed to improve maternal health and opportunities for improving uptake of services. Methods and findings Using the 2014 Ghana Demographic and Health Survey, we examined the effects of individual and community-level factors on antenatal care, facility-based delivery, and post-natal care. Multilevel logistic regression models were used to examine the effects of individual and community-level factors on the outcome variables. Our analysis revealed that overall utilization of antenatal, facility-based delivery and post-natal care was substantial across the board; however, both individual and community-level factors were significant predictors of these maternal health outcomes. Wealthier and better educated women were more likely to use antenatal services and facility-based delivery; in contrast poor and uneducated women were more likely to use antenatal and postnatal care but not facility-based delivery. Additionally, use of National Health Insurance Scheme was statistically associated with the utilization of maternal health services. Conclusions The findings point to areas where services can be better tailored to meet community-specific needs. Policy makers must consider factors such as educational levels and economic security at both individual and community-levels that shape women’s preferences and uptake of maternal health care in Ghana.
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Affiliation(s)
- Joseph Adu
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Eric Tenkorang
- Department of Sociology, Faculty of Humanities and Social Sciences, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Emmanuel Banchani
- Department of Sociology, Faculty of Humanities and Social Sciences, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Jill Allison
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Shree Mulay
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
- * E-mail:
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Cofie LE, Barrington C, Sodzi-Tettey S, Ennett S, Maman S, Singh K. A qualitative study of women's network social support and facility delivery in rural Ghana. PLoS One 2018; 13:e0206429. [PMID: 30399180 PMCID: PMC6219853 DOI: 10.1371/journal.pone.0206429] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 10/12/2018] [Indexed: 11/19/2022] Open
Abstract
Similar to many sub-Saharan African countries, maternal mortality in Ghana ranks among the highest (39th) globally. Prior research has demonstrated the impact of social network characteristics on health facility delivery in sub-Saharan Africa. However, in-depth examination of the function of all members in a woman's network, in providing various types of support for the woman's pregnancy and related care, is limited. We qualitatively explore how women's network social support influences facility delivery. Qualitative data came from a mixed methods evaluation of a Maternal and Newborn Health Referral project in Ghana. In 2015 we conducted in-depth interviews with mothers (n = 40) and husbands (n = 20), and 4 focus group interviews with mothers-in-law. Data were analyzed using narrative summaries and thematic coding procedures to first examine women's network composition during their pregnancy and childbirth experiences. We then compared those who had homebirths versus facility births on how network social support influenced their place of childbirth. Various network members were involved in providing women with social support. We found differences in how informational and instrumental support impacted women's place of childbirth. Network members of women who had facility delivery mobilized resources to support women's facility delivery. Among women who had homebirth but their network members advocated for them to have facility delivery, members delayed making arrangements for the women's facility delivery. Women who had homebirth, and their network members advocated homebirth, received support to give birth at home. Network support for women's pregnancy-related care affects their place of childbirth. Hence, maternal health interventions must develop strategies to prioritize informational and instrumental support for facility-based pregnancy and delivery care.
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Affiliation(s)
- Leslie E. Cofie
- Department of Health Education and Promotion, East Carolina University, Greenville, United States of America
| | - Clare Barrington
- Department of Health Behavior, University of North Carolina, Gillings School of Global Public Health, United States of America
- Carolina Population Center, University of North Carolina, United States of America
| | | | - Susan Ennett
- Department of Health Behavior, University of North Carolina, Gillings School of Global Public Health, United States of America
| | - Suzzane Maman
- Department of Health Behavior, University of North Carolina, Gillings School of Global Public Health, United States of America
| | - Kavita Singh
- Carolina Population Center, University of North Carolina, United States of America
- Department of Maternal and Child Health, University of North Carolina, Gillings, School of Global Public Health, United States of America
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Kifle MM, Kesete HF, Gaim HT, Angosom GS, Araya MB. Health facility or home delivery? Factors influencing the choice of delivery place among mothers living in rural communities of Eritrea. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2018; 37:22. [PMID: 30348219 PMCID: PMC6196428 DOI: 10.1186/s41043-018-0153-1] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/08/2018] [Indexed: 05/10/2023]
Abstract
BACKGROUND In Eritrea, despite high antenatal care (ANC) use, utilization of health facilities for child birth is still low and with marked variations between urban and rural areas. Understanding the reasons behind the poor use of these services in a rural setting is important to design targeted strategies and address the challenge contextually. This study aimed to determine factors that influence women's choice of delivery place in selected rural communities in Eritrea. METHODS A cross-sectional survey of 309 women aged 15-49 years with a delivery in the last 1-2 years prior to the survey was conducted in a randomly selected villages of Hadish Adi, Serea, Genseba, Kelay Bealtat, Dirko, Mai Leham, Kudo Abour, Adi Koho, and Leayten. Data were collected using an interviewer administered questionnaire. Chi-square tests were used to explore association between variables. Using odds ratios with 95% confidence intervals with p < 0.05 taken as statically significant association, bivariate and multivariate logistic regression analysis were used to identify factors that affect the choice of delivery place. RESULTS Overall, 75.4% of the respondents delivered their last child at home while 24.6% delivered in health facility. Women whose husband's had no formal education were less likely [AOR = 0.02; 95% CI 0.01-0.54] to deliver in health facility. Women who had joint decision-making with husbands on delivery place [AOR = 5.42; 95% CI 1.78-16.49] and women whose husbands choose health facility delivery [AOR = 2.32; 95% CI 1.24-5.11] were more likely to have health facility delivery. Respondents who had medium wealth status [AOR = 3.78; 95% CI 1.38-10.37] have access to health facility within 2 km distance [AOR = 14.67; 95% CI 2.30-93.45] and women with traditional means of transport [AOR = 9.78; 95% CI 1.23-77.26] were also more likely to deliver in health facility. Women who read newspaper daily or infrequently had three [AOR = 3.77; 95% CI 1.12-4.04] and almost three times [AOR = 2.95; 95% CI 1.01-8.59] higher odds of delivering in health facility. Similarly, women who have knowledge about complications during delivery [AOR = 4.39; 95% CI 1.63-11.83], good perception on the quality of care they received [AOR = 9.52; 95% CI 1.91-47.50], had previous facility delivery [AOR = 2.69; 95% CI 0.94-7.68], have negative experiences of delivery outcomes in her community [AOR = 1.31; 95% CI 1.00-4.96], and women who perceive home delivery as life threatening [AOR = 1.84; 95% CI 1.46-3.38] were more likely to deliver in health facility. CONCLUSION To increase health facility delivery, raising women's awareness on the benefits of delivering in health facility, male involvement in the use of maternal health services, increasing women decision-making power, addressing common barriers of lack of transport, and compensations for transport expenses to alleviate the cost of transport are recommended. Efforts to shorten distance to reach health facility and health education focusing on the potential threats of delivering at home at the individual and community level can have substantial contribution to increase health facility delivery in rural communities of Eritrea.
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Affiliation(s)
- Meron Mehari Kifle
- Department of Epidemiology and Biostatistics, School of Public Health, Asmara College of Health Sciences, Asmara, Eritrea.
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Emaway Altaye D, Karim AM, Betemariam W, Fesseha Zemichael N, Shigute T, Scheelbeek P. Effects of family conversation on health care practices in Ethiopia: a propensity score matched analysis. BMC Pregnancy Childbirth 2018; 18:372. [PMID: 30255781 PMCID: PMC6157286 DOI: 10.1186/s12884-018-1978-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Maternal and newborn mortality rates in Ethiopia are among the highest in sub-Saharan Africa. The majority of deaths take place during childbirth or within the following 48 h. Therefore, ensuring facility deliveries with emergency obstetric and newborn care services available and immediate postnatal follow-up are key strategies to increase survival. In early 2014, the Family Conversation was implemented in 115 rural districts in Ethiopia, covering about 17 million people. It aimed to reduce maternal and newborn mortality by promoting institutional delivery, early postnatal care and immediate newborn care practices. More than 6000 Health Extension Workers were trained to initiate home-based Family Conversations with pregnant women and key household decision-makers. These conversations included discussions on birth preparedness, postpartum and newborn care needs to engage key household stakeholders in supporting women during their pregnancy, labor and postpartum periods. This paper examines the effects of the Family Conversation strategy on maternal and neonatal care practices. METHODS We used cross-sectional data from a representative sample of 4684 women with children aged 0-11 months from 115 districts collected between December 2014 and January 2015. We compared intrapartum and newborn care practices related to the most recent childbirth, between those who reported having participated in a Family Conversation during pregnancy, and those who had not. Propensity score matched analysis was used to estimate average treatment effects of the Family Conversation strategy on intrapartum and newborn care practices, including institutional delivery, early postnatal and immediate breastfeeding. RESULTS About 17% of the respondents reported having had a Family Conversation during their last pregnancy. Average treatment effects of 7, 12, 9 and 16 percentage-points respectively were found for institutional deliveries, early postnatal care, clean cord care and thermal care of the newborn (p < 0.05). CONCLUSION We found evidence that Family Conversation, and specifically the involvement of household members who were major decision-makers, was associated with better intrapartum and newborn care practices. This study adds to the evidence base that involving husbands and mothers-in-law, as well as pregnant women, in behavior change communication interventions could be critical for improving maternal and newborn care and therewith lowering mortality rates.
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Affiliation(s)
- Dessalew Emaway Altaye
- The Last Ten Kilometers Project (L10K) 2020, JSI Research & Training Institute, Inc., Bole Sub-City, Kebele 03/05, Hs #, 2111 Addis Ababa, Ethiopia
| | - Ali Mehryar Karim
- JSI Research & Training Institute, Inc., 1616 N Fort Myer Dr, 16th Floor, Arlington, VA 22209 USA
| | - Wuleta Betemariam
- The Last Ten Kilometers Project (L10K) 2020, JSI Research & Training Institute, Inc., Bole Sub-City, Kebele 03/05, Hs #, 2111 Addis Ababa, Ethiopia
| | - Nebreed Fesseha Zemichael
- The Last Ten Kilometers Project (L10K) 2020, JSI Research & Training Institute, Inc., Bole Sub-City, Kebele 03/05, Hs #, 2111 Addis Ababa, Ethiopia
| | - Tesfaye Shigute
- The Last Ten Kilometers Project (L10K) 2020, JSI Research & Training Institute, Inc., Bole Sub-City, Kebele 03/05, Hs #, 2111 Addis Ababa, Ethiopia
| | - Pauline Scheelbeek
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Koné S, Hürlimann E, Baikoro N, Dao D, Bonfoh B, N'Goran EK, Utzinger J, Jaeger FN. Pregnancy-related morbidity and risk factors for fatal foetal outcomes in the Taabo health and demographic surveillance system, Côte d'Ivoire. BMC Pregnancy Childbirth 2018; 18:216. [PMID: 29879939 PMCID: PMC5992668 DOI: 10.1186/s12884-018-1858-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 05/25/2018] [Indexed: 11/25/2022] Open
Abstract
Background Reliable, population-based data on pregnancy-related morbidity and mortality, and risk factors for fatal foetal outcomes are scarce for low- and middle-income countries. Yet, such data are essential for understanding and improving maternal and neonatal health and wellbeing. Methods Within the 4-monthly surveillance rounds of the Taabo health and demographic surveillance system (HDSS) in south-central Côte d’Ivoire, all women of reproductive age identified to be pregnant between 2011 and 2014 were followed-up. A questionnaire pertaining to antenatal care, pregnancy-related morbidities, delivery circumstances, and birth outcome was administered to eligible women. Along with sociodemographic information retrieved from the Taabo HDSS repository, these data were subjected to penalized maximum likelihood logistic regression analysis, to determine risk factors for fatal foetal outcomes. Results A total of 2976 pregnancies were monitored of which 118 (4.0%) resulted in a fatal outcome. Risk factors identified by multivariable logistic regression analysis included sociodemographic factors of the expectant mother, such as residency in a rural area (adjusted odds ratio (aOR) = 2.87; 95% confidence interval (CI) 1.31–6.29) and poorest wealth tertile (aOR = 1.79; 95% CI 1.02–3.14), a history of miscarriage (aOR = 23.19; 95% CI 14.71–36.55), non-receipt of preventive treatment such as iron/folic acid supplementation (aOR = 3.15; 95% CI 1.71–5.80), only two doses of tetanus vaccination (aOR = 2.59; 95% CI 1.56–4.30), malaria during pregnancy (aOR = 1.94; 95% CI 1.21–3.11), preterm birth (aOR = 4.45; 95% CI 2.82–7.01), and delivery by caesarean section (aOR = 13.03; 95% CI 4.24–40.08) or by instrumental delivery (aOR = 5.05; 95% CI 1.50–16.96). Women who paid for delivery were at a significantly lower odds of a fatal foetal outcome (aOR = 0.39; 95% CI 0.25–0.74). Conclusions We identified risk factors for fatal foetal outcomes in a mainly rural HDSS site of Côte d’Ivoire. Our findings call for public health action to improve access to, and use of, quality services of ante- and perinatal care.
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Affiliation(s)
- Siaka Koné
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, 01 BP 1303, Abidjan, 01, Côte d'Ivoire. .,INDEPTH Network, Accra, Ghana.
| | - Eveline Hürlimann
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Nahoua Baikoro
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, 01 BP 1303, Abidjan, 01, Côte d'Ivoire
| | - Daouda Dao
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, 01 BP 1303, Abidjan, 01, Côte d'Ivoire
| | - Bassirou Bonfoh
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, 01 BP 1303, Abidjan, 01, Côte d'Ivoire
| | - Eliézer K N'Goran
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, 01 BP 1303, Abidjan, 01, Côte d'Ivoire.,Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Fabienne N Jaeger
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Jacobs C, Michelo C, Moshabela M. Why do rural women in the most remote and poorest areas of Zambia predominantly attend only one antenatal care visit with a skilled provider? A qualitative inquiry. BMC Health Serv Res 2018; 18:409. [PMID: 29871624 PMCID: PMC5989442 DOI: 10.1186/s12913-018-3212-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 05/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While focused antenatal care (ANC) has served as an entry point in the continuum of care for both mothers and children, fewer than a third of pregnant women in the most remote and poorest communities of Zambia achieve the four ANC visits recommended by the World Health Organization. Current evidence suggests that attending ANC provided by a skilled healthcare worker at least once is common and associated with skilled birth attendance. The aim of this study was to explain why one ANC visit with a skilled provider seemed more common than four ANC visits among women in the remote and poorest districts of Zambia. METHODS A qualitative case study design was conducted in 2012 among 84 participants in the selected remote and poorest districts of Zambia. Focus group discussions were conducted with mothers and community health volunteers, while key informant interviews were conducted with healthcare providers. Thematic analysis was conducted. RESULTS Most women delayed starting antenatal care visits due to uncertainties about the timing for initiation of ANC and due to waiting for confirmation of the pregnancy by an elderly woman. Attendance of ANC once with a skilled provider was due to the need to assess their health status and that of their baby. In some facilities, attendance of ANC at least once was enforced by financial charges imposed on women for late ANC initiation, and/or incentives provided by nongovernmental organisations. Unavailability of services at health posts closest to these remote communities led to failure to return for subsequent ANC visits. Women's livelihoods such as nomadic lifestyles made it harder for them to initiate and make additional ANC visits. CONCLUSION The popularity of ANC attendance once by a skilled provider among the remote and poorest women of Zambia was explained through perceived unavoidable social and economic barriers to care, and the punitive and incentive procedures implemented by health services. Maximising comprehensive care by skilled healthcare workers in the one visit a woman makes at the health facility, may lead to optimal utilisation of quality focused ANC. Enhancing community-based interventions may increase the potential to reach the vulnerable populations.
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Affiliation(s)
- Choolwe Jacobs
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa. .,School of Public Health, Department of Epidemiology & Biostatistics, Section for Surveillance & Disease Control, University of Zambia, Lusaka, Zambia. .,Strategic Centre for Health Systems Metrics and Evaluations (SCHEME), School of Public Health, University of Zambia, Lusaka, Zambia.
| | - Charles Michelo
- School of Public Health, Department of Epidemiology & Biostatistics, Section for Surveillance & Disease Control, University of Zambia, Lusaka, Zambia.,Strategic Centre for Health Systems Metrics and Evaluations (SCHEME), School of Public Health, University of Zambia, Lusaka, Zambia
| | - Mosa Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.,Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa
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Tiruneh FN, Chuang KY, Ntenda PAM, Chuang YC. Unwanted pregnancy, pregnancy loss, and other risk factors for intimate partner violence in the Democratic Republic of the Congo. Women Health 2017; 58:983-1000. [PMID: 29111920 DOI: 10.1080/03630242.2017.1377800] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The Democratic Republic of the Congo (DRC) has one of the highest rates of violence against women in the world; however, few studies have focused on this issue. In this study, we assessed the interrelationship among intimate partner violence (IPV), unintended pregnancy, pregnancy loss, and other sociodemographic factors in the DRC. Our analyses were based on data from the DRC demographic and health survey, conducted from November 2013 to February 2014. We constructed generalized estimating equation models to analyze the data from a sample of 5,120 married women. Our results showed that having a husband or partner who exhibited controlling behaviors, women who justified wife-beating, having a mother who had experienced IPV, and having a husband or partner who consumed alcohol were positively associated with IPV, whereas decision-making autonomy among women was negatively associated with IPV. In the community, the proportion of women who had experienced IPV and that of those who had completed secondary or higher education were positively and negatively associated with any IPV type, respectively. In addition, emotional IPV and any IPV type were positively associated with pregnancy loss. Our results indicate the necessity of implementing programs targeting gender equality at both individual and community levels.
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Affiliation(s)
| | - Kun-Yang Chuang
- a School of Public Health , Taipei Medical University , Taipei City , Taiwan
| | - Peter A M Ntenda
- a School of Public Health , Taipei Medical University , Taipei City , Taiwan
| | - Ying-Chih Chuang
- a School of Public Health , Taipei Medical University , Taipei City , Taiwan
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Dougherty L, Stammer E, Derbile E, Dery M, Yahaya W, Gle DB, Otieno J, Fotso JC. A Mixed-Methods Evaluation of a Community-Based Behavior Change Program to Improve Maternal Health Outcomes in the Upper West Region of Ghana. JOURNAL OF HEALTH COMMUNICATION 2017; 23:80-90. [PMID: 29265915 PMCID: PMC6157528 DOI: 10.1080/10810730.2017.1414901] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The Community Benefits Health (CBH) program introduced a community-based behavior change intervention to address social norms and cultural practices influencing maternal health and breastfeeding behaviors in rural Ghana. The purpose of this study was to determine if CBH influenced maternal health outcomes by stimulating community-level support in woman's social networks. METHODS A mixed-methods study was conducted to evaluate changes in six antenatal/postpartum care, birth attendance, and breastfeeding behaviors in response to the CBH intervention and to assess how the program was implemented and to what extent conditions during implementation influenced the results. RESULTS We found increases in five of the six outcomes in both the intervention and control areas. Qualitative findings indicated that this may have resulted from program spillover. We considered the dose of exposure to program activities and found that women were significantly more likely to practice maternal health behaviors with increased exposure to program activities while controlling for study area and time. CONCLUSIONS Overall, we determined that exposure to the CBH program significantly improved uptake of three of the six study outcomes, indicating that efforts aimed at increasing communication across women and their social networks may lead to improved health outcomes.
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Affiliation(s)
| | - Emily Stammer
- International Dvision, John Snow International, Arlington, VA
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Cofie LE, Barrington C, Singh K, Sodzi-Tettey S, Ennett S, Maman S. Structural and functional network characteristics and facility delivery among women in rural Ghana. BMC Pregnancy Childbirth 2017; 17:425. [PMID: 29258456 PMCID: PMC5735796 DOI: 10.1186/s12884-017-1611-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 12/04/2017] [Indexed: 11/10/2022] Open
Abstract
Background Health facility births contribute to the prevention of maternal deaths. Although theoretical and empirical evidence suggest that social network characteristics influence facility delivery, examination of this relationship in sub-Saharan Africa is limited. We determined whether network structural and functional characteristics were associated with, or had an interactive effect on health facility delivery in rural Ghana. Methods Data on mothers (n = 783) aged 15–49 years came from a Maternal and Newborn Health Referral (MNHR) project in Ghana, and included egocentric network data on women’s social network characteristics. Using multivariate logistic regression we examined the relationship between facility delivery and women’s network structure and functions, as well as the interaction between network characteristics and facility delivery. Results Higher levels of instrumental support (e.g. help with daily chores or seeking health care [OR: 1.60, CI: 1.10–2.34]) and informational support (OR: 1.66, CI: 1.08–2.54) were significantly associated with higher odds of facility delivery. Social norms, such as knowing more women who had received pregnancy-related care in a facility, were significantly associated with higher odds of facility delivery (OR: 2.20, CI: 1.21–4.00). The number of network members that respondents lived nearby moderated the positive relationship between informational support and facility delivery. Additionally, informational support moderated the positive relationship between facility delivery and the number of women the respondents knew who had utilized a facility for pregnancy-related care. Conclusions Social support from network members was critical to facilitating health facility delivery, and support was further enhanced by women’s network structure and norms favoring facility delivery. Maternal health interventions to increase facility delivery uptake should target women’s social networks.
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Affiliation(s)
- Leslie E Cofie
- Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-0128, USA.
| | - Clare Barrington
- Department of Health Behavior, University of North Carolina, Gillings School of Global Public Health, 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599-7440, USA.,Carolina Population Center, University of North Carolina, CB#81200, Chapel Hill, NC, 27599-7440, USA
| | - Kavita Singh
- Carolina Population Center, University of North Carolina, CB#81200, Chapel Hill, NC, 27599-7440, USA.,Department of Maternal and Child Health, University of North Carolina, Gillings School of Global Public Health, 401 Rosenau Hall, CB #7445, Chapel Hill, NC, 27599-7445, USA
| | | | - Susan Ennett
- Department of Health Behavior, University of North Carolina, Gillings School of Global Public Health, 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599-7440, USA
| | - Suzanne Maman
- Department of Health Behavior, University of North Carolina, Gillings School of Global Public Health, 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599-7440, USA
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Ruark A, Chase R, Hembling J, Davis VR, Perrin PC, Brewster-Lee D. Measuring couple relationship quality in a rural African population: Validation of a Couple Functionality Assessment Tool in Malawi. PLoS One 2017; 12:e0188561. [PMID: 29190769 PMCID: PMC5708731 DOI: 10.1371/journal.pone.0188561] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/09/2017] [Indexed: 11/18/2022] Open
Abstract
Available data suggest that individual and family well-being are linked to the quality of women’s and men’s couple relationships, but few tools exist to assess couple relationship functioning in low- and middle-income countries. In response to this gap, Catholic Relief Services has developed a Couple Functionality Assessment Tool (CFAT) to capture valid and reliable data on various domains of relationship quality. This tool is designed to be used by interventions which aim to improve couple and family well-being as a means of measuring the effectiveness of these interventions, particularly related to couple relationship quality. We carried out a validation study of the CFAT among 401 married and cohabiting adults (203 women and 198 men) in rural Chikhwawa District, Malawi. Using psychometric scales, the CFAT addressed six domains of couple relationship quality (intimacy, partner support, sexual satisfaction, gender roles, decision-making, and communication and conflict management), and included questions on intimate partner violence. We used exploratory factor analysis to assess scale performance of each domain and produce a shortened Relationship Quality Index (RQI) composed of items from five relationship quality domains. This article reports the performance of the RQI. Internal reliability and validity of the RQI were found to be good. Regression analyses examined the relationship of the RQI to outcomes important to health and development: intra-household cooperation, positive health behaviors, intimate partner violence, and gender-equitable norms. We found many significant correlations between RQI scores and these couple- and family-level development issues. There is a need to further validate the tool with use in other populations as well as to continue to explore whether the observed linkages between couple functionality and development outcomes are causal relationships.
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Affiliation(s)
- Allison Ruark
- Department of Medicine, Brown University, Providence, Rhode Island, United States of America
- * E-mail:
| | - Rachel Chase
- Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, United States of America
| | - John Hembling
- Catholic Relief Services, Baltimore, Maryland, United States of America
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Philibert A, Ravit M, Ridde V, Dossa I, Bonnet E, Bedecarrats F, Dumont A. Maternal and neonatal health impact of obstetrical risk insurance scheme in Mauritania: a quasi experimental before-and-after study. Health Policy Plan 2017; 32:405-417. [PMID: 27935801 PMCID: PMC5886239 DOI: 10.1093/heapol/czw142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 01/04/2023] Open
Abstract
A variety of health financing schemes shaped on pre-payment scheme have been implemented across Sub-Saharan Africa (SSA) to address the Millennium Development Goals (MDGs). In Mauritania, the Obstetric Risk Insurance package (ORI) focusing on maternal and perinatal health has been progressively implemented at the health district level since 2002. Here, our main objective was to assess the effectiveness of the ORI in increasing facility-based delivery rates, as well as increases in family planning, antenatal and postnatal care, caesarean delivery and neonatal health, from demographic and health survey data between 2002 and 2011. We also examined whether the effects of the ORI varied between strata of the population. The study was based on a quasi-experimental before-and-after design to assess the causal link between availability of ORI and increase in use of maternal health services and neonatal mortality. In combination with geographical information system, difference-in-differences and odd ratio approaches were used to address our objectives. Indicators of access to care for pregnant women and neonatal health and improved in both non-intervention and intervention groups during the study period. There was no global effect of the availability of ORI on facility-based delivery rates, nor on the use of antenatal and postnatal care services, except for qualified antenatal services. However, delivery rates in local health centres with ORI increased more rapidly than in those with no ORI, the contrary was shown for hospitals. Caesarean delivery and family planning decreased with ORI. Although late neonatal mortality rates remained low in the country, a significant decrease was seen in districts without ORI. Except for some strata of the population, ORI has not really met its objective of attracting more pregnant women towards facility-based health care.
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Affiliation(s)
- Aline Philibert
- Interdisciplinary Research Centre on Well-being, Health, Society and Environment (Cinbiose), University of Quebec in Montreal, Montreal, Québec, Canada.,Research Institute for Development, Université Paris Descartes, COMUE Sorbonnes Paris Cité, UMR MERIT, Paris, France
| | - Marion Ravit
- IRD, CEPED, UMR 196, Université Paris Descartes-Institut de Recherche pour le Développement (IRD), Paris, France
| | - Valéry Ridde
- School of Public Health (ESPUM), University of Montreal, Montreal, Quebec, Canada.,University of Montreal Public Health Research Institute (IRSPUM), Montreal, Quebec, Canada
| | - Inès Dossa
- Research Institute for Development, Université Paris Descartes, COMUE Sorbonnes Paris Cité, UMR MERIT, Paris, France
| | - Emmanuel Bonnet
- UMR IDEES CNRS 6266, Université de Normandie/IRD RESILIENCE 236, Caen, France
| | - Florent Bedecarrats
- Agence Française de Développement (AFD), Evaluation Unit, Research and Knowledge Developpement, Paris, France
| | - Alexandre Dumont
- IRD, CEPED, UMR 196, Université Paris Descartes-Institut de Recherche pour le Développement (IRD), Paris, France
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Kyei-Nimakoh M, Carolan-Olah M, McCann TV. Access barriers to obstetric care at health facilities in sub-Saharan Africa-a systematic review. Syst Rev 2017; 6:110. [PMID: 28587676 PMCID: PMC5461715 DOI: 10.1186/s13643-017-0503-x] [Citation(s) in RCA: 178] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 05/19/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Since 2000, the United Nations' Millennium Development Goals, which included a goal to improve maternal health by the end of 2015, has facilitated significant reductions in maternal morbidity and mortality worldwide. However, despite more focused efforts made especially by low- and middle-income countries, targets were largely unmet in sub-Saharan Africa, where women are plagued by many challenges in seeking obstetric care. The aim of this review was to synthesise literature on barriers to obstetric care at health institutions in sub-Saharan Africa. METHODS This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases were electronically searched to identify studies on barriers to health facility-based obstetric care in sub-Saharan Africa, in English, and dated between 2000 and 2015. Combinations of search terms 'obstetric care', 'access', 'barriers', 'developing countries' and 'sub-Saharan Africa' were used to locate articles. Quantitative, qualitative and mixed-methods studies were considered. A narrative synthesis approach was employed to synthesise the evidence and explore relationships between included studies. RESULTS One hundred and sixty articles met the inclusion criteria. Currently, obstetric care access is hindered by several demand- and supply-side barriers. The principal demand-side barriers identified were limited household resources/income, non-availability of means of transportation, indirect transport costs, a lack of information on health care services/providers, issues related to stigma and women's self-esteem/assertiveness, a lack of birth preparation, cultural beliefs/practices and ignorance about required obstetric health services. On the supply-side, the most significant barriers were cost of services, physical distance between health facilities and service users' residence, long waiting times at health facilities, poor staff knowledge and skills, poor referral practices and poor staff interpersonal relationships. CONCLUSION Despite similarities in obstetric care barriers across sub-Saharan Africa, country-specific strategies are required to tackle the challenges mentioned. Governments need to develop strategies to improve healthcare systems and overall socioeconomic status of women, in order to tackle supply- and demand-side access barriers to obstetric care. It is also important that strategies adopted are supported by research evidence appropriate for local conditions. Finally, more research is needed, particularly, with regard to supply-side interventions that may improve the obstetric care experience of pregnant women. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2014 CRD42014015549.
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Affiliation(s)
- Minerva Kyei-Nimakoh
- Disciplines of Nursing and Midwifery, Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, PO Box 14428, Melbourne, Victoria 8001 Australia
| | - Mary Carolan-Olah
- Disciplines of Nursing and Midwifery, Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, PO Box 14428, Melbourne, Victoria 8001 Australia
| | - Terence V. McCann
- Disciplines of Nursing and Midwifery, Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, PO Box 14428, Melbourne, Victoria 8001 Australia
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Solanke BL, Amoo EO, Idowu AE. Improving postnatal checkups for mothers in West Africa: A multilevel analysis. Women Health 2017; 58:221-245. [PMID: 28278013 DOI: 10.1080/03630242.2017.1292343] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study examined multilevel factors related to postnatal checkups for mothers in selected West African countries. The study analyzed data from Demographic and Health Surveys (DHS) for five West African countries: Sierra Leone (2013), Cote d'Ivoire (2012), Guinea (2012), Niger (2012), and Liberia (2013). The weighted sample sizes were 2125 (Cote d'Ivoire), 2908 (Guinea), 1905 (Liberia), 5660 (Niger), and 3754 (Sierra Leone). The outcome variable was maternal postnatal checkups. The explanatory variables were community and individual/household characteristics. With the use of Stata 12, the chi-square statistic and multilevel mixed-effects logistic regression were applied. More than two-thirds of respondents in Guinea and Niger did not receive a postnatal checkup after their last birth, while in Cote d'Ivoire, Liberia, and Sierra Leone, more than half of respondents received a postnatal checkup after their last childbirth. Community characteristics accounted for the following variations in postnatal checkups: 33.9% (Cote d'Ivoire), 37.2% (Guinea), 27.0% (Liberia), 33.5% (Niger), and 37.2% (Sierra Leone). Community factors thus had important relations to use of postnatal care in West Africa. Interventions targeting more community variables, particularly community education and poverty, may further improve postnatal care in West Africa.
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Affiliation(s)
- Bola Lukman Solanke
- a Department of Demography and Social Statistics , Obafemi Awolowo University , Ile-Ife , Nigeria.,b Demography and Population Studies Programme , University of the Witwatersrand , Johannesburg-Braamfontein , South Africa
| | - Emmanuel O Amoo
- b Demography and Population Studies Programme , University of the Witwatersrand , Johannesburg-Braamfontein , South Africa.,c Department of Demography and Social Statistics , Covenant University , Ota , Nigeria
| | - Adenike Esther Idowu
- b Demography and Population Studies Programme , University of the Witwatersrand , Johannesburg-Braamfontein , South Africa.,d Department of Sociology , Covenant University , Ota , Nigeria
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Cheptum JJ, Gitonga MM, Mutua EM, Mukui SJ, Ndambuki JM, Koima WJ. Perception about traditional birth attendants by men and women of reproductive age in rural Migori County, Kenya. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2017. [DOI: 10.1016/j.ijans.2017.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Singh K, Speizer I, Kim ET, Lemani C, Phoya A. Reaching vulnerable women through maternity waiting homes in Malawi. Int J Gynaecol Obstet 2016; 136:91-97. [PMID: 28099696 DOI: 10.1002/ijgo.12013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/01/2016] [Accepted: 10/11/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine whether two maternity waiting homes (MWHs) supported by the Safe Motherhood Initiative are reaching vulnerable women during the early phase of their implementation. METHODS A cross-sectional interview-based study was conducted among women who attended two centers in Malawi with attached MWHs (Area 25 Health Centre, Lilongwe; and Kasungu District Hospital, Kasungu). Between April and June 2015, exit interviews were conducted among MWH users and non-users. RESULTS Compared with non-users, MWH users at Area 25 were significantly more likely to report a prior spontaneous abortion (10/46 [21.7%] vs 5/95 [5.3%]; P=0.006) and to be in the lowest wealth quintile (4/87 [4.6%] vs 0/150; P=0.029). Although not significant, a greater percentage of MWH users at Kasungu District Hospital than non-users had a prior stillbirth (6/84 [7.1%] vs 0/77) or spontaneous abortion (3/84 [3.6%] vs 2/77 [2.6%]), and were in the lowest wealth quintile (15/175 [8.6%] vs 5/141 [3.5%]). MWH users at Kasungu lived further from the hospital than did non-MWH users, although the difference was not significant (mean 6.81±9.1 km vs 4.05±7.42 km; P=0.067). CONCLUSION MWHs offer a promising strategy to reduce maternal mortality in Malawi and other low-income countries.
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Affiliation(s)
- Kavita Singh
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ilene Speizer
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eunsoo Timothy Kim
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Ann Phoya
- Safe Motherhood Initiative, Lilongwe, Malawi
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Sialubanje C, Massar K, Kirch EM, van der Pijl MSG, Hamer DH, Ruiter RAC. Husbands' experiences and perceptions regarding the use of maternity waiting homes in rural Zambia. Int J Gynaecol Obstet 2016; 133:108-11. [PMID: 26873126 DOI: 10.1016/j.ijgo.2015.08.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 08/03/2015] [Accepted: 12/21/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore men's experience and beliefs regarding the use of maternity waiting homes (MWHs) in Kalomo District, Zambia. METHODS As part of a qualitative study, in-depth interviews with the husbands/partners of women attending the under-five clinic at a health center with a MWH were conducted between April 1 and May 31, 2014. Men aged 18-50 years whose partner/wife was of reproductive age and who had lived in the area for more than 6 months were eligible for inclusion. RESULTS Overall, 24 husbands/partners were interviewed in seven rural health centers. Men perceived many potential benefits of MWHs, including improved access to facility-based skilled delivery services and treatment in case of labor complications. Their many roles included decision making and securing funds for transport, food, cleaning materials, and clothes for the mother and the neonate to use during and after labor. However, limited financial resources made it difficult for them to provide for their wives and newborns, and usually led to delays in their decisions about MWH use. Poor conditions in MWHs and the lack of basic social and healthcare needs meant some men had forbidden their wives/partners from using the facilities. CONCLUSION Important intervention targets for improving access to MWHs and skilled birth attendance have been identified.
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Affiliation(s)
- Cephas Sialubanje
- Ministry of Health, Monze District Medical Office, Monze, Zambia; Maastricht University, Department of Work and Social Psychology, Maastricht, Netherlands.
| | - Karlijn Massar
- Maastricht University, Department of Work and Social Psychology, Maastricht, Netherlands
| | - Elisa M Kirch
- Maastricht University, Faculty of Health, Medicine and Life Science, Department of Global Health, Maastricht, Netherlands
| | - Marit S G van der Pijl
- Maastricht University, Faculty of Health, Medicine and Life Science, Department of Global Health, Maastricht, Netherlands
| | - Davidson H Hamer
- Zambia Centre for Applied Health Research and Development, Lusaka, Zambia; Centre for Global Health and Development, Boston University School of Public Health, Boston, MA, USA; Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Robert A C Ruiter
- Maastricht University, Department of Work and Social Psychology, Maastricht, Netherlands
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Tekelab T, Yadecha B, Melka AS. Antenatal care and women's decision making power as determinants of institutional delivery in rural area of Western Ethiopia. BMC Res Notes 2015; 8:769. [PMID: 26651489 PMCID: PMC4676818 DOI: 10.1186/s13104-015-1708-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 11/17/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Delivery by skilled birth attendance serves as an indicator of progress towards reducing maternal mortality. In Ethiopia, the proportions of births attended by skilled personnel were very low 15 % and Oromia region 14.7 %. The current study identified factors associated with utilization of institutional delivery among married women in rural area of Western Ethiopia. METHODS A community based cross-sectional study was employed from January 2 to January 31, 2015 among mothers who gave birth in the last 2 years in rural area of East Wollega Zone. A multi-stage sampling procedure was used to select 798 study participants. A pre-tested structured questionnaire was used to collect data and female high school graduates data collectors were involved in the data collection process. Bivariate and multivariable logistic regression model was fit and statistical significance was determined through a 95 % confidence level. RESULTS The study revealed that 39.7 % of the mothers delivered in health facilities. Age 15-24 years (AOR 4.20, 95 % CI 2.07-8.55), 25-34 years (AOR 2.21, 95 % CI 1.32-3.69), women's educational level (AOR 2.00, 95 % CI 1.19-3.34), women's decision making power (AOR 2.11, 95 % CI 1.54-2.89), utilization of antenatal care (ANC) during the index pregnancy (AOR 1.56, 95 % CI 1.08-2.23) and parity one (AOR 2.20, 95 % CI 1.10-4.38) showed significant positive association with utilization of institutional delivery. CONCLUSION AND RECOMMENDATION In this study proportion of institutional delivery were low (39.7 %). Age, women's literacy status, women's decision making power, ANC practice and numbers of live birth were found important predictors of institutional delivery. The findings of current study highlight the importance of boosting women involvement in formal education and decision making power. Moreover since ANC is big pillar for the remaining maternal health services effort should be there to increase ANC service utilization.
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Affiliation(s)
- Tesfalidet Tekelab
- College of Medical and Health Sciences, Wollega University, P.O.Box 395, Nekemte, Ethiopia.
| | - Birhanu Yadecha
- College of Medical and Health Sciences, Wollega University, P.O.Box 395, Nekemte, Ethiopia.
| | - Alemu Sufa Melka
- College of Medical and Health Sciences, Wollega University, P.O.Box 395, Nekemte, Ethiopia.
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Yeji F, Shibanuma A, Oduro A, Debpuur C, Kikuchi K, Owusu-Agei S, Gyapong M, Okawa S, Ansah E, Asare GQ, Nanishi K, Williams J, Addei S, Tawiah C, Yasuoka J, Enuameh Y, Sakeah E, Wontuo P, Jimba M, Hodgson A. Continuum of Care in a Maternal, Newborn and Child Health Program in Ghana: Low Completion Rate and Multiple Obstacle Factors. PLoS One 2015; 10:e0142849. [PMID: 26650388 PMCID: PMC4674150 DOI: 10.1371/journal.pone.0142849] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 10/26/2015] [Indexed: 01/05/2023] Open
Abstract
Background Slow progress has been made in achieving the Millennium Development Goals 4 and 5 in Ghana. Ensuring continuum of care (at least four antenatal visits; skilled birth attendance; postnatal care within 48 hours, at two weeks, and six weeks) for mother and newborn is crucial in helping Ghana achieve these goals and beyond. This study examined the levels and factors associated with continuum of care (CoC) completion among Ghanaian women aged 15–49. Methods A retrospective cross-sectional survey was conducted among women who experienced live births between January 2011 and April 2013 in three regions of Ghana. In a two-stage random sampling method, 1,500 women with infants were selected and interviewed about maternal and newborn service usage in line with CoC. Multiple logistic regression models were used to assess factors associated with CoC completion. Results Only 8.0% had CoC completion; the greatest gap and contributor to the low CoC was detected between delivery and postnatal care within 48 hours postpartum. About 95% of women had a minimum of four antenatal visits and postnatal care at six weeks postpartum. A total of 75% had skilled assisted delivery and 25% received postnatal care within 48 hours. Factors associated with CoC completion at 95% CI were geographical location (OR = 0.35, CI 0.13–0.39), marital status (OR = 0.45; CI 0.22–0.95), education (OR = 2.71; CI 1.11–6.57), transportation (OR = 1.97; CI 1.07–3.62), and beliefs about childhood illnesses (OR = 0.34; CI0.21–0.61). Conclusion The continuum of care completion rate is low in the study site. Efforts should focus on increasing postnatal care within 48 hours and overcoming the known obstacles to increasing the continuum of care completion rate.
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Affiliation(s)
- Francis Yeji
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Upper-East, Ghana
- * E-mail: ;
| | - Akira Shibanuma
- Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113–0033, Japan
| | - Abraham Oduro
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Upper-East, Ghana
| | - Cornelius Debpuur
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Upper-East, Ghana
| | - Kimiyo Kikuchi
- Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113–0033, Japan
| | - Seth Owusu-Agei
- Kintampo Health Research Centre, P.O. Box 200, Kintampo, Brong-Ahafo, Ghana
| | - Margaret Gyapong
- Dodowa Health Research Centre, P.O. Box DD1, Dodowa, Greater Accra, Ghana
| | - Sumiyo Okawa
- Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113–0033, Japan
| | - Evelyn Ansah
- Research and Development Division, Ghana Health Service, Accra MB 190, Ghana
| | | | - Keiko Nanishi
- Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113–0033, Japan
| | - John Williams
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Upper-East, Ghana
| | - Sheila Addei
- Dodowa Health Research Centre, P.O. Box DD1, Dodowa, Greater Accra, Ghana
| | - Charlotte Tawiah
- Kintampo Health Research Centre, P.O. Box 200, Kintampo, Brong-Ahafo, Ghana
| | - Junko Yasuoka
- Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113–0033, Japan
| | - Yeetey Enuameh
- Kintampo Health Research Centre, P.O. Box 200, Kintampo, Brong-Ahafo, Ghana
| | - Evelyn Sakeah
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Upper-East, Ghana
| | - Peter Wontuo
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Upper-East, Ghana
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113–0033, Japan
| | - Abraham Hodgson
- Research and Development Division, Ghana Health Service, Accra MB 190, Ghana
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Sialubanje C, Massar K, Hamer DH, Ruiter RAC. Reasons for home delivery and use of traditional birth attendants in rural Zambia: a qualitative study. BMC Pregnancy Childbirth 2015; 15:216. [PMID: 26361976 PMCID: PMC4567794 DOI: 10.1186/s12884-015-0652-7] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 09/07/2015] [Indexed: 01/16/2023] Open
Abstract
Background Despite the policy change stopping traditional birth attendants (TBAs) from conducting deliveries at home and encouraging all women to give birth at the clinic under skilled care, many women still give birth at home and TBAs are essential providers of obstetric care in rural Zambia. The main reasons for pregnant women’s preference for TBAs are not well understood. This qualitative study aimed to identify reasons motivating women to giving birth at home and seek the help of TBAs. This knowledge is important for the design of public health interventions focusing on promoting facility-based skilled birth attendance in Zambia. Methods We conducted ten focus group discussions (n = 100) with women of reproductive age (15–45 years) in five health centre catchment areas with the lowest institutional delivery rates in the district. In addition, a total of 30 in-depth interviews were conducted comprising 5 TBAs, 4 headmen, 4 husbands, 4 mothers, 4 neighbourhood health committee (NHC) members, 4 community health workers (CHWs) and 5 nurses. Perspectives on TBAs, the decision-making process regarding home delivery and use of TBAs, and reasons for preference of TBAs and their services were explored. Results Our findings show that women’s lack of decision- making autonomy regarding child birth, dependence on the husband and other family members for the final decision, and various physical and socioeconomic barriers including long distances, lack of money for transport and the requirement to bring baby clothes and food while staying at the clinic, prevented them from delivering at a clinic. In addition, socio-cultural norms regarding childbirth, negative attitude towards the quality of services provided at the clinic, made most women deliver at home. Moreover, most women had a positive attitude towards TBAs and perceived them to be respectful, skilled, friendly, trustworthy, and available when they needed them. Conclusion Our findings suggest a need to empower women with decision-making skills regarding childbirth and to lower barriers that prevent them from going to the health facility in time. There is also need to improve the quality of existing facility-based delivery services and to strengthen linkages between TBAs and the formal health system.
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Affiliation(s)
- Cephas Sialubanje
- Ministry of Health, Monze District Medical Office, P.O. Box 660144, Monze, Zambia. .,Department of Work and Social Psychology, Maastricht University, P.O. Box 616, , 6200MD, Maastricht, The Netherlands.
| | - Karlijn Massar
- Department of Work and Social Psychology, Maastricht University, P.O. Box 616, , 6200MD, Maastricht, The Netherlands.
| | - Davidson H Hamer
- Zambia Centre for Applied Health Research and Development, P.O. Box 30910, Lusaka, Zambia. .,Centre for Global Health and Development Boston University, Crosstown 3rd floor, 801 Massachusetts Avenue, Boston, MA, 02118, USA. .,Department of International Health, Boston University School of Public Health, Crosstown 3rd floor, 801 Massachusetts Avenue, Boston, MA, 02118, USA.
| | - Robert A C Ruiter
- Department of Work and Social Psychology, Maastricht University, P.O. Box 616, , 6200MD, Maastricht, The Netherlands.
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Bayu H, Fisseha G, Mulat A, Yitayih G, Wolday M. Missed opportunities for institutional delivery and associated factors among urban resident pregnant women in South Tigray Zone, Ethiopia: a community-based follow-up study. Glob Health Action 2015; 8:28082. [PMID: 26361348 PMCID: PMC4565844 DOI: 10.3402/gha.v8.28082] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 05/29/2015] [Accepted: 07/14/2015] [Indexed: 12/03/2022] Open
Abstract
Background Every pregnant woman is considered to be at risk and some risks may not always be foreseeable or detectable. Therefore, the presence of a skilled birth attendant at every delivery is considered to be the most critical intervention in reducing maternal mortality and morbidity. In Ethiopia, the proportion of births attended by skilled personnel in urban settings can be as low as 10%. Therefore, the main purpose of this research was to identify factors affecting unplanned home delivery in urban settings, where there is relatively good access in principle to modern healthcare institutions. Design A community-based follow-up study was conducted from 17 January 2014 to 30 August 2014, among second- and third-trimester pregnant women who had planned for institutional delivery in South Tigray Zone. A systematic sampling technique was used to get a total of 522 study participants. A pre-tested and structured questionnaire was used to collect relevant data. Bivariate and multivariate data analyses were performed using SPSS version 16.0. Results The study revealed that among 465 pregnant women who planned for institutional delivery, 134 (28.8%) opted out and delivered at their home (missed opportunity). Single women (AOR 2.34, 95% CI 1.17–4.68), illiterate mothers (AOR 6.14, 95% CI 2.20–17.2), absence of antenatal clinic visit for indexed pregnancy (AOR 3.11, 95% CI 1.72–5.61), absence of obstetric complications during the index pregnancy (AOR 2.96, 95% CI 1.47–5.97), poor autonomy (AOR 2.11, 95% CI 1.27–3.49), and absence of birth preparedness and complication readiness (AOR 3.83, 95% CI 2.19–6.70) were significant predictors of unplanned home delivery. Conclusions A significant proportion of pregnant women missed the opportunity of modern delivery assistance. Educational status, antenatal care status, lack of obstetric complications, poor autonomy, and lack of birth preparedness and complication readiness were among the important predictors of unplanned home delivery.
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Affiliation(s)
- Hinsermu Bayu
- Department of Midwifery, College of Health Sciences, Mekelle University, Mekelle, Ethiopia;
| | - Girmastion Fisseha
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Amlaku Mulat
- Department of Midwifery, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Gebre Yitayih
- Department of Nursing, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Mengistu Wolday
- Department of Midwifery, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Sialubanje C, Massar K, van der Pijl MSG, Kirch EM, Hamer DH, Ruiter RAC. Improving access to skilled facility-based delivery services: Women's beliefs on facilitators and barriers to the utilisation of maternity waiting homes in rural Zambia. Reprod Health 2015; 12:61. [PMID: 26148481 PMCID: PMC4493824 DOI: 10.1186/s12978-015-0051-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 06/25/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternity waiting homes (MWHs) are aimed at improving access to facility-based skilled delivery services in rural areas. This study explored women's experiences and beliefs concerning utilisation of MWHs in rural Zambia. Insight is needed into women's experiences and beliefs to provide starting points for the design of public health interventions that focus on promoting access to and utilisation of MWHs and skilled birth attendance services in rural Zambia. METHODS We conducted 32 in-depth interviews with women of reproductive age (15-45 years) from nine health centre catchment areas. A total of twenty-two in-depth interviews were conducted at a health care facility with a MWH and 10 were conducted at a health care facility without MWHs. Women's perspectives on MWHs, the decision-making process regarding the use of MWHs, and factors affecting utilisation of MWHs were explored. RESULTS Most women appreciated the important role MWHs play in improving access to skilled birth attendance and improving maternal health outcomes. However several factors such as women's lack of decision-making autonomy, prevalent gender inequalities, low socioeconomic status and socio-cultural norms prevent them from utilising these services. Moreover, non availability of funds to buy the requirements for the baby and mother to use during labour at the clinic, concerns about a relative to remain at home and take care of the children and concerns about the poor state and lack of basic social and healthcare needs in the MWHs--such as adequate sleeping space, beddings, water and sanitary services, food and cooking facilities as well as failure by nurses and midwives to visit the mothers staying in the MWHs to ensure their safety prevent women from using MWHs. CONCLUSION These findings highlight important targets for interventions and suggest a need to provide women with skills and resources to ensure decision-making autonomy and address the prevalent gender and cultural norms that debase their social status. Moreover, there is need to consider provision of basic social and healthcare needs such as adequate sleeping space, beddings, water and sanitary services, food and cooking facilities, and ensuring that nurses and midwives conduct regular visits to the mothers staying in the MWHs.
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Affiliation(s)
- Cephas Sialubanje
- Ministry of Health, Monze District Medical Office, P.O. Box 660144, Monze, Zambia. .,Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200MD, Maastricht, The Netherlands.
| | - Karlijn Massar
- Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200MD, Maastricht, The Netherlands.
| | - Marit S G van der Pijl
- Department of Global Health, Maastricht University, Faculty of Health, Medicine and Life Science, P.O. Box 616, 6200MD, Maastricht, The Netherlands.
| | - Elisa Maria Kirch
- Department of Global Health, Maastricht University, Faculty of Health, Medicine and Life Science, P.O. Box 616, 6200MD, Maastricht, The Netherlands.
| | - Davidson H Hamer
- Zambia Centre for Applied Health Research and Development, P.O. Box 30910, Lusaka, Zambia. .,Centre for Global Health and Development Boston University, Crosstown 3rd floor, 801 Massachusetts Avenue, Boston, MA, 02118, USA. .,Department of International Health, Boston University School of Public Health, Crosstown 3rd floor, 801 Massachusetts Avenue, Boston, MA, 02118, USA.
| | - Robert A C Ruiter
- Department of Work and Social Psychology, Maastricht University, P.O. Box 616, 6200MD, Maastricht, The Netherlands.
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